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General NPI Number Information
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NPI Number | 1043467145
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Entity Type | Individual
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Provider Name | MARK P WILSON FNP
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Gender | Male
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 11555 CULEBRA RD LOT 84
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4826
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Country | US
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Telephone | 210-379-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 11555 CULEBRA RD LOT 84
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4826
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Country | US
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Telephone | 210-379-0501
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Fax | 210-314-4761
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 648078
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP116948
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License Number State | TX
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