Healthcare Provider Details

I. General information

NPI: 1114528155
Provider Name (Legal Business Name): AARON WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 TRAILVIEW DR
LITTLE ELM TX
75068-6882
US

IV. Provider business mailing address

PO BOX 1232
LITTLE ELM TX
75068-1232
US

V. Phone/Fax

Practice location:
  • Phone: 214-681-1968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: