Individual
JESSICA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 SIAM RD, ELIZABETHTON, TN 37643-4839
(423) 676-0188
Mailing address
1717 SIAM RD, ELIZABETHTON, TN 37643-4839
(423) 676-0188
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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