MEDICARE: MRS. ISABELLA WILSON MSN, APRN, AGNP-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
1	363L00000X	Nurse Practitioner	RN279820	GA
2	163W00000X	Registered Nurse	RN279820	GA

General Provider Information

NPI Number	:	1770288714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ISABELLA WILSON MSN, APRN, AGNP-C

Provider Business Mailing Address
First Line	:	1005 BOULDER DR
Second Line	:
City	:	GRAY
State	:	GA
Zip	:	31032-6141
Country	:	US
Telephone Number	:	478-621-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 FREDERICA RD
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-1910
Country	:	US
Telephone Number	:	912-638-9988
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	11/09/2025

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