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NPI Code Detail

MEDICARE: PHOEBE WILSON

MEDICARE: PHOEBE 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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1477236750
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHOEBE WILSON
Provider Business Mailing Address
First Line : 4502 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-2536
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4502 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-2536
Country : US
Telephone Number : 918-660-3842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2023
Last Update Date : 01/15/2026

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Directions to “ PHOEBE WILSON ” Practice Location

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