MEDICARE: MARTHA JO WILSON FNP-C

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	363L00000X	Nurse Practitioner	1741	WY
2	363LF0000X	Family Nurse Practitioner	1741	WY

General Provider Information

NPI Number	:	1144726670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JO WILSON FNP-C

Provider Business Mailing Address
First Line	:	4140 CENTENNIAL HILLS BLVD STE A
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-3265
Country	:	US
Telephone Number	:	307-265-7205
Fax Number	:	307-235-6262

Provider Business Practice Location Address
First Line	:	2546 E 2ND ST STE 200
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-2062
Country	:	US
Telephone Number	:	307-265-1110
Fax Number	:	307-265-1108

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	03/06/2026

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Directions to “ MARTHA JO WILSON FNP-C” Practice Location

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