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General NPI Number Information
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NPI Number | 1043644198
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH WILSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 4622 BATTLEFIELD PKWY
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City | RINGGOLD
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State | GA
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Zip | 30736-8004
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Country | US
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Telephone | 423-602-2750
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Fax | 423-602-2762
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Provider Business Mailing Address
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Address Line | 2358 LIFESTYLE WAY STE 100
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4907
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Country | US
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Telephone | 423-602-2750
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Fax | 423-602-2762
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 17797
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License Number State | TN
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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 | RN297501
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License Number State | GA
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