Healthcare Provider Details

I. General information

NPI: 1205160082
Provider Name (Legal Business Name): JENNIFER VELEZ WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 4TH ST
BAIRD TX
79504-5314
US

IV. Provider business mailing address

PO BOX 2435
ALBANY TX
76430-8020
US

V. Phone/Fax

Practice location:
  • Phone: 325-854-1409
  • Fax:
Mailing address:
  • Phone: 325-762-2447
  • Fax: 325-762-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP118291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: