| NPI | 1831515246 |
|---|---|
| Former Name | JENESSA WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11734006-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6044) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2023-11-27 |