Healthcare Provider Details

I. General information

NPI: 1750097242
Provider Name (Legal Business Name): BARBARA MOORE WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA HOUCHINS

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22708 MAIN ST
COURTLAND VA
23837-1127
US

IV. Provider business mailing address

PO BOX 639972
CINCINNATI OH
45263-9972
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-2007
  • Fax: 757-935-5551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024186326
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: