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Individual
MRS. TERESA LYNNE WILSON
Active
Individual
MRS. TERESA LYNNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
PA01815
TX
363A00000X
Physician Assistant
Primary
PA01815
TX
363AM0700X
Medical Physician Assistant
PA 01815
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285326902
—
TX
Enumeration date
05/03/2007
Last updated
06/25/2014
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