Healthcare Provider Details

I. General information

NPI: 1528185535
Provider Name (Legal Business Name): VALERIE FAYE WILSON LPN, MX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

15633 COULTERVILLE RD
SALE CREEK TN
37373-7707
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8030
  • Fax: 423-209-8031
Mailing address:
  • Phone: 423-451-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberMX 0000004097
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN0000057538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: