Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 3147 | WV |
NPI | 1003238338 |
---|---|
Provider Name | Jessica D Wilson |
First Address | Point Pleasant, WV 25550-2031 |
Second Address | Huntington, WV 25702-1318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 05/06/2017 |