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General NPI Number Information
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NPI Number | 1033757638
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Entity Type | Organization
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Legal Business Name | WILSON MEDICAL STAFFING PLLC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 2603 KENTUCKY AVE STE 305
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City | PADUCAH
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State | KY
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Zip | 42003-3814
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Country | US
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Telephone | 270-558-5456
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Fax | 270-558-5471
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Provider Business Mailing Address
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Address Line | PO BOX 9485
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City | PADUCAH
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State | KY
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Zip | 42002-9485
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Country | US
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Telephone | 270-558-5456
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Fax | 270-558-5471
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. RICHARD SCOTT WILSON
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Credential | MD
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Telephone | 270-558-5456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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