Healthcare Provider Details

I. General information

NPI: 1699610782
Provider Name (Legal Business Name): TERRANCE JAMOL WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8475 POLLUX CT
CINCINNATI OH
45231-4132
US

IV. Provider business mailing address

8475 POLLUX CT
CINCINNATI OH
45231-4132
US

V. Phone/Fax

Practice location:
  • Phone: 513-266-0178
  • Fax:
Mailing address:
  • Phone: 513-266-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: