| NPI | 1306036603 |
|---|---|
| Former Name | JESSICA L WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA1782) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003006) |
| 363A00000X Physician Assistant (Licence: KY PA1782) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2023-09-20 |