Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APN0000011646 | TN |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 841783 | TX |
NPI | 1003990383 |
---|---|
Provider Name | Mrs. Nicole Elaine Wilson-Carr |
First Address | Morgantown, WV 26506 |
Second Address | Morgantown, WV 26506-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 18/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330021201 | (05) | TX |