MEDICARE: JENNIFER SUZETTE WILSON ARNP (PMHNP)

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9394055	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1-076818 CRNP	AL

General Provider Information

NPI Number	:	1982063988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUZETTE WILSON ARNP (PMHNP)

Provider Business Mailing Address
First Line	:	206 RESCIA AVE
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5933
Country	:	US
Telephone Number	:	256-413-7154
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 RESCIA AVE
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5933
Country	:	US
Telephone Number	:	256-413-7154
Fax Number	:

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

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	01/19/2017

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