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General NPI Number Information
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NPI Number | 1750097242
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Entity Type | Individual
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Provider Name | BARBARA MOORE WILSON NP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 22708 MAIN ST
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City | COURTLAND
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State | VA
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Zip | 23837-1127
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Country | US
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Telephone | 757-653-2007
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Fax | 757-935-5551
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Provider Business Mailing Address
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Address Line | PO BOX 639972
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City | CINCINNATI
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State | OH
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Zip | 45263-9972
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024186326
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License Number State | VA
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