Individual
JILL BETHANY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
374 E GRAND AVE, CARBONDALE, IL 62901-3962
(618) 453-3311
Mailing address
374 E GRAND AVE, CARBONDALE, IL 62901-3962
(618) 453-3311
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209009467
IL
363L00000X
Nurse Practitioner
277003898
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.009467
ILLINOIS ADVANCE PRACTICE NURSE LICENSE
IL
05
—
370966854002
—
IL
05
—
370966854005
—
IL
01
—
CF3444
RR MEDICARE
IL
Enumeration date
03/30/2012
Last updated
11/26/2025
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