Individual
MRS. TONYA HENRY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
301 MED TECH PKWY STE 200, JOHNSON CITY, TN 37604-2364
(423) 794-1300
(423) 794-1820
Mailing address
PO BOX 3889, JOHNSON CITY, TN 37602-3889
(423) 794-2450
(423) 283-9480
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7633
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3349326
—
TN
01
—
4070554
BCBST
TN
Enumeration date
06/21/2005
Last updated
01/20/2016
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