Healthcare Provider Details

I. General information

NPI: 1013748177
Provider Name (Legal Business Name): MEAGAN R WILSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CENTRAL AVE SE
ALBUQUERQUE NM
87108-2408
US

IV. Provider business mailing address

2808 ALOYSIA LN NW
ALBUQUERQUE NM
87104-1765
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5885
  • Fax: 505-272-5888
Mailing address:
  • Phone: 505-288-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80283
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number80283
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number80283
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: