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General NPI Number Information
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NPI Number | 1023881943
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Entity Type | Individual
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Provider Name | BRITTANY WILSON
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 608 OLD ROUTE 66 # MO
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City | SAINT ROBERT
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State | MO
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Zip | 65584-3730
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Country | US
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Telephone | 573-336-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 19580 LYLE LN
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City | WAYNESVILLE
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State | MO
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Zip | 65583-3571
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023044267
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License Number State | MO
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