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General NPI Number Information
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NPI Number | 1982418562
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Entity Type | Individual
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Provider Name | OLIVIA KAZIAH WILSON NP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 513 GEORGIA AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37403-3402
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Country | US
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Telephone | 423-619-9426
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Fax |
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Provider Business Mailing Address
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Address Line | 185 LOGAN LN
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City | DAYTON
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State | TN
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Zip | 37321-5071
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Country | US
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Telephone | 423-619-9426
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 38123
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License Number State | TN
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