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General NPI Number Information
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NPI Number | 1508524026
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Entity Type | Individual
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Provider Name | JESSICA KAY WILSON HM61029496
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 1924 VAN WORMER ST
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City | CENTRALIA
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State | WA
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Zip | 98531-1947
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Country | US
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Telephone | 360-330-2984
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SW 10TH ST
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City | CHEHALIS
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State | WA
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Zip | 98532-4706
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Country | US
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Telephone | 360-523-3115
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HM61029496
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License Number State | WA
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