Individual
JENNIFER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
017366
NY
363AM0700X
Medical Physician Assistant
Primary
017366
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03791619
—
NY
Enumeration date
01/03/2014
Last updated
01/16/2026
Update your record
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