| NPI | 1134930597 |
|---|---|
| Former Name | DALLAS RENEE WILCOX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP031818) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2025-10-07 |