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General NPI Number Information
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NPI Number | 1558000117
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Entity Type | Individual
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Provider Name | JAQUELL WILSON
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 8014 MIDLOTHIAN TPKE STE 318
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5291
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Country | US
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Telephone | 804-866-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 4807 TOOLEY DR
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City | CHESTER
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State | VA
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Zip | 23831-6631
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Country | US
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Telephone | 434-480-6111
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001301085
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 0001301085
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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