Individual
MS. JO LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 12TH AVE, STE. 100, FORT WORTH, TX 76104-2518
(817) 810-0600
(817) 236-1394
Mailing address
4916 OVERTON PLZ, FORT WORTH, TX 76109-4415
(817) 529-1920
(817) 334-0235
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
226528
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162546901
—
TX
Enumeration date
08/31/2006
Last updated
03/18/2009
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