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NPI Code Detail

MEDICARE: NICOLE WILSON

MEDICARE: NICOLE WILSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164350831
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE WILSON
Provider Business Mailing Address
First Line : 3415 BATAAN MEMORIAL W
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-5012
Country : US
Telephone Number : 505-392-3482
Fax Number :
Provider Business Practice Location Address
First Line : 203 YMCA WAY
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1195
Country : US
Telephone Number : 270-576-3736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ NICOLE WILSON ” Practice Location

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