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Individual
JENNIFER WILSON
Active
Individual
JENNIFER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186968701
—
TX
05
—
186968702
—
TX
01
—
75-2616977-007
TRICARE DOUGLAS
TX
01
—
75-2616977-041
TRICARE
TX
01
—
752616977002
TRICARE
TX
01
—
8CW412
BCBS
TX
01
—
P00385523
TC GROUP CR1017
TX
01
—
P00967753
MEDICARE RR
TX
Enumeration date
10/27/2006
Last updated
10/14/2014
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