Individual
JACQUELYN N. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2800 IVY RD, CHARLOTTESVILLE, VA 22903
(434) 243-3600
(434) 244-4454
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110003305
VA
363AS0400X
Surgical Physician Assistant
Primary
0110003305
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114247426
—
VA
Enumeration date
06/09/2010
Last updated
08/10/2023
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