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General NPI Number Information
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NPI Number | 1710466214
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Entity Type | Individual
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Provider Name | JASMINE PATTERSON WILSON
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 114 MORLAKE DR STE 101A
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City | MOORESVILLE
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State | NC
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Zip | 28117-9209
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Country | US
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Telephone | 704-438-1706
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Fax |
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Provider Business Mailing Address
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Address Line | 337 GAITHER RD
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City | BELMONT
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State | NC
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Zip | 28012-7600
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Country | US
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Telephone | 704-438-1706
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 13192
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License Number State | NC
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