MEDICARE: APRIL LEIGH EASTERWOOD-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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-17-28859	OTHER	TN	BCBA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861909517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL LEIGH EASTERWOOD-WILSON

Provider Business Mailing Address
First Line	:	1321 VANTAGE POINTE
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-4068
Country	:	US
Telephone Number	:	615-574-4654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 VANTAGE POINTE
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-4068
Country	:	US
Telephone Number	:	615-574-4654
Fax Number	:

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/03/2018

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