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NPI Code Detail

MEDICARE: MICHAEL ANDREW WILSON JR.

MEDICARE: MICHAEL ANDREW WILSON JR.
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 TechnicianOK

General Provider Information

NPI Number : 1487584801
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANDREW WILSON JR.
Provider Business Mailing Address
First Line : 4908 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5712
Country : US
Telephone Number : 918-984-9153
Fax Number :
Provider Business Practice Location Address
First Line : 4908 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5712
Country : US
Telephone Number : 918-984-9153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ MICHAEL ANDREW WILSON JR. ” Practice Location

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