Individual
MS. JACQUELINE LATIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
225 N CLIFTON AVE, LOUISVILLE, KY 40206-2496
(502) 794-3894
(502) 794-2873
Mailing address
225 N CLIFTON AVE, LOUISVILLE, KY 40206-2496
(502) 794-3894
(502) 794-2873
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3013705
KY
Other
Enumeration date
09/08/2019
Last updated
03/13/2020
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