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General NPI Number Information
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NPI Number | 1386424208
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Entity Type | Individual
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Provider Name | ALLISON THERIOT WILSON NP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 153 TOWN BLVD
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City | OPELOUSAS
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State | LA
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Zip | 70570-6971
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Country | US
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Telephone | 337-942-4453
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Fax |
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Provider Business Mailing Address
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Address Line | 140 LUXFORD WAY
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City | CARENCRO
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State | LA
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Zip | 70520-4509
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Country | US
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Telephone | 337-251-1824
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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 | 231228
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License Number State | LA
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