MEDICARE: MRS. YAH UTEE 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP292110	GA

General Provider Information

NPI Number	:	1629936778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YAH UTEE WILSON

Provider Business Mailing Address
First Line	:	4189 CASTLEOAK DR
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-0958
Country	:	US
Telephone Number	:	215-349-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4189 CASTLEOAK DR
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-0958
Country	:	US
Telephone Number	:	215-349-0405
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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