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General NPI Number Information
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NPI Number | 1326786765
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Entity Type | Individual
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Provider Name | SHAMEKA DAYSHAN WILSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 5350 TOMAH DR STE 3600
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6991
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Country | US
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Telephone | 970-806-4972
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Fax | 888-965-4615
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Provider Business Mailing Address
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Address Line | 5350 TOMAH DR STE 3600
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6991
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Country | US
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Telephone | 970-806-4972
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Fax | 888-965-4615
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2020131915
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | C-APN.0102397-C-NP
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License Number State | CO
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