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General NPI Number Information
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NPI Number | 1831071893
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Entity Type | Individual
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Provider Name | JESSICA CORDELIA WILSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 5959 BIG TREE RD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2291
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Country | US
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Telephone | 716-422-5677
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Fax |
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Provider Business Mailing Address
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Address Line | 193 NORWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1915
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Country | US
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Telephone | 716-829-9444
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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 | F356864-01
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License Number State | NY
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