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General NPI Number Information
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NPI Number | 1649509332
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Entity Type | Individual
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Provider Name | ALICIA ANN WILSON RN, MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 400 E TICKLE ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3120
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Country | US
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Telephone | 731-288-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E TICKLE ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3120
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Country | US
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Telephone | 731-288-3610
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4000583
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4000583
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 150829
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14842
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14842
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License Number State | TN
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