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General NPI Number Information
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NPI Number | 1285023440
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Entity Type | Individual
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Provider Name | JENNIFER WILSON APRN
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 9601 BAPTIST HEALTH DR SUITE 860
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6321
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Country | US
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Telephone | 501-975-7455
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Fax | 501-975-3631
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Provider Business Mailing Address
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Address Line | 7 GREYMOSS CV
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3856
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Country | US
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Telephone | 949-282-9671
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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 | A004185
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License Number State | AR
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