MEDICARE: JESSICA GAIL WILSON MD

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	207N00000X	Dermatology Physician	20771	NH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207N00000X	Dermatology Physician	332549	LA

General Provider Information

NPI Number	:	1699270520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GAIL WILSON MD

Provider Business Mailing Address
First Line	:	190 GREENBRIER BLVD STE 103
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-7237
Country	:	US
Telephone Number	:	985-898-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 GREENBRIER BLVD STE 103
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-7237
Country	:	US
Telephone Number	:	985-898-7999
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	12/16/2025

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