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General NPI Number Information
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NPI Number | 1659217206
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Entity Type | Individual
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Provider Name | JESSICA WILSON
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Gender | Female
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 1016 OLD LATTA HWY
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City | DILLON
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State | SC
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Zip | 29536-7614
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Country | US
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Telephone | 843-339-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 COREYS CT
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City | DILLON
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State | SC
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Zip | 29536-8064
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Country | US
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Telephone |
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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 | 163WI0600X
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Taxonomy Name | Infection Control Registered Nurse
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License Number | 226765
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License Number State | SC
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