Healthcare Provider Details

I. General information

NPI: 1013803618
Provider Name (Legal Business Name): EMILY G WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR STE 100
NORTH CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-7990
  • Fax: 804-330-2701
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001294701
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024193955
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024193955
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: