Individual
ASHLEY DIANNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12400 SW 15TH ST, YUKON, OK 73099-7734
(405) 376-2461
Mailing address
4113 PALMETTO BLUFF DR, MUSTANG, OK 73064-9060
(318) 537-3707
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20130399
LA
Other
Enumeration date
04/09/2026
Last updated
04/09/2026
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