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General NPI Number Information
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NPI Number | 1245945922
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Entity Type | Individual
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Provider Name | ELIZABETH ANN WILSON
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Gender | Female
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 6221 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5836
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Country | US
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Telephone | 580-351-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5836
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Country | US
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Telephone | 580-713-1126
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 317531
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License Number State | OK
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