Individual
DEIDRE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, A-GNPN, MSN
Contact information
Practice address
4000 EMBARCADERO DR, ARLINGTON, TX 76014-4101
(817) 542-4800
(817) 524-4089
Mailing address
752 N MAIN ST UNIT 1067, MANSFIELD, TX 76063-3280
(843) 790-1827
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
843837
TX
207Q00000X
Family Medicine Physician
AP136799
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
AP136799
TX
Other
Enumeration date
03/22/2016
Last updated
10/25/2024
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