MEDICARE: MRS. CHRISTINA M 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	363LF0000X	Family Nurse Practitioner	APN29338	TN

General Provider Information

NPI Number	:	1326610841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA M WILSON FNP

Provider Business Mailing Address
First Line	:	127 CRESTVIEW PARK DR STE 209
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2856
Country	:	US
Telephone Number	:	615-446-5121
Fax Number	:	615-446-1357

Provider Business Practice Location Address
First Line	:	2340 FAIRVIEW BLVD STE 100
Second Line	:
City	:	FAIRVIEW
State	:	TN
Zip	:	37062-9458
Country	:	US
Telephone Number	:	629-205-3108
Fax Number	:	615-446-1357

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

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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