Individual
DARSHAWNDA SHARRAINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP113002
TX
363LA2200X
Adult Health Nurse Practitioner
AP113002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173189502
—
TX
05
—
173189503
—
TX
05
—
173189504
—
TX
01
—
8Y3715
BCBS
TX
01
—
P00612704
RAILROAD MEDICARE
TX
Enumeration date
02/13/2007
Last updated
06/06/2018
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