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Individual
TIFFANY KAY WILSON
Active
Individual
TIFFANY KAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2381
OK
363A00000X
Physician Assistant
Primary
PA04018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185065301
—
TX
Enumeration date
06/14/2006
Last updated
05/19/2021
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