Individual
BRENT WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2460 CURTIS ELLIS DR, ROCKY MOUNT, NC 27804-2237
(252) 885-2463
Mailing address
4518 HARVEST LN SW, WILSON, NC 27893-9699
(252) 885-2463
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07077
NC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/07/2016
Last updated
02/13/2017
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