Individual
JACQUETTA NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3950 KRESGE WAY STE 308, LOUISVILLE, KY 40207-4637
(502) 895-8911
(502) 895-8977
Mailing address
PO BOX 9203, BELFAST, ME 04915-9203
(502) 895-9627
(502) 895-8977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3013748
KY
Other
Enumeration date
10/03/2019
Last updated
12/01/2020
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