Healthcare Provider Details

I. General information

NPI: 1467423970
Provider Name (Legal Business Name): CAROL WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13168 MEADOWVIEW SQUARE
MEADOWVIEW VA
24361-3328
US

IV. Provider business mailing address

PO BOX 729
SALTVILLE VA
24370-0729
US

V. Phone/Fax

Practice location:
  • Phone: 276-944-3999
  • Fax: 276-944-3882
Mailing address:
  • Phone: 276-496-4492
  • Fax: 276-496-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: