Individual
JORDAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 NEW STATE HWY, RAYNHAM, MA 02767-5423
(781) 666-2711
(781) 666-2712
Mailing address
100 NEW STATE HWY, RAYNHAM, MA 02767-5423
(781) 666-2711
(781) 666-2712
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
9110440
FL
363A00000X
Physician Assistant
Primary
PA101388
MA
363A00000X
Physician Assistant
PA60855409
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2101119
—
WA
Enumeration date
07/17/2017
Last updated
03/12/2025
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