Healthcare Provider Details

I. General information

NPI: 1629853650
Provider Name (Legal Business Name): AMY NICOLE WILSON M.ED., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY NICOLE KING MA

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 7TH ST
CHICKASHA OK
73018-3301
US

IV. Provider business mailing address

508 W HIGHWAY 277
NINNEKAH OK
73067-3804
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-4786
  • Fax:
Mailing address:
  • Phone: 405-278-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11968
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: