MEDICARE: MARK P WILSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	648078	TX
2	363LF0000X	Family Nurse Practitioner	AP116948	TX

General Provider Information

NPI Number	:	1043467145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK P WILSON FNP

Provider Business Mailing Address
First Line	:	11555 CULEBRA RD LOT 84
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4826
Country	:	US
Telephone Number	:	210-379-0501
Fax Number	:	210-314-4761

Provider Business Practice Location Address
First Line	:	11555 CULEBRA RD LOT 84
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4826
Country	:	US
Telephone Number	:	210-379-0501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	01/16/2026

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