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NPI Code Detail

MEDICARE: CORA WILSON PA-C

MEDICARE: CORA WILSON PA-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
1363A00000XPhysician Assistant4795TN

General Provider Information

NPI Number : 1760149991
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORA WILSON PA-C
Provider Business Mailing Address
First Line : 1120 SAMS ST
Second Line :
City : COOKEVILLE
State : TN
Zip : 38506-4006
Country : US
Telephone Number : 931-528-7312
Fax Number : 931-528-7377
Provider Business Practice Location Address
First Line : 1120 SAMS ST
Second Line :
City : COOKEVILLE
State : TN
Zip : 38506-4006
Country : US
Telephone Number : 931-528-7312
Fax Number : 931-528-7377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2021
Last Update Date : 12/31/2025

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Directions to “ CORA WILSON PA-C” Practice Location

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