# HETTIE TABITHA WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467512608
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA0365 | TX | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 10/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 182578802 | — | TX |
| 01 | — | 8N4694 | BLUE CROSS BLUE SHIELD | TX |
| 01 | — | 8Y8829 | BCBSTX | TX |
| 01 | — | P00227237 | RAILROAD MEDICARE | TX |