Individual
MELISSA JANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
110 EXECUTIVE PARK DR, CLINTON, TN 37716-6876
(865) 494-9241
(865) 374-2121
Mailing address
110 EXECUTIVE PARK DR, CLINTON, TN 37716-6876
(865) 494-9241
(865) 374-2121
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
23186
TN
363L00000X
Nurse Practitioner
3012980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q044813
—
TN
Enumeration date
09/28/2017
Last updated
08/04/2021
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