MEDICARE: COURTNEY ELIZABETH WILSON PA

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	363A00000X	Physician Assistant	0010-11921	NC

General Provider Information

NPI Number	:	1558948638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ELIZABETH WILSON PA

Provider Business Mailing Address
First Line	:	2756 W ARLINGTON BLVD APT 302
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4075
Country	:	US
Telephone Number	:	224-944-7794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2756 W ARLINGTON BLVD APT 302
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4075
Country	:	US
Telephone Number	:	224-944-7794
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	07/07/2023

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