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NPI Code Detail

MEDICARE: TIFFANY CELESTE WILSON NP-C

MEDICARE: TIFFANY CELESTE WILSON NP-C
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
1363LF0000XFamily Nurse PractitionerA005849AR

General Provider Information

NPI Number : 1740765205
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY CELESTE WILSON NP-C
Provider Business Mailing Address
First Line : 400 S MAIN ST STE 100
Second Line :
City : SEARCY
State : AR
Zip : 72143-7801
Country : US
Telephone Number : 501-368-0132
Fax Number : 501-368-0123
Provider Business Practice Location Address
First Line : 400 S MAIN ST STE 100
Second Line :
City : SEARCY
State : AR
Zip : 72143-7801
Country : US
Telephone Number : 501-368-0132
Fax Number : 501-368-0123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2018
Last Update Date : 10/01/2018

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Directions to “ TIFFANY CELESTE WILSON NP-C” Practice Location

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