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General NPI Number Information
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NPI Number | 1871319152
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Entity Type | Individual
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Provider Name | ASHLEY C WILSON RN
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 133 MEADOWBROOK LN
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City | FORDLAND
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State | MO
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Zip | 65652-7204
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Country | US
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Telephone | 417-860-5232
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Fax |
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Provider Business Mailing Address
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Address Line | 778 STATE HIGHWAY FF
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City | FORDLAND
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State | MO
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Zip | 65652-7410
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Country | US
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Telephone | 417-988-6442
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 2019037123
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License Number State | MO
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