Healthcare Provider Details

I. General information

NPI: 1740138270
Provider Name (Legal Business Name): ERICA MICHELLE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W LOUIS HENNA BLVD
ROUND ROCK TX
78681-2300
US

IV. Provider business mailing address

11521 N FM 620 RD STE 945
AUSTIN TX
78726-1115
US

V. Phone/Fax

Practice location:
  • Phone: 512-516-8800
  • Fax:
Mailing address:
  • Phone: 512-318-2559
  • Fax: 512-782-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: