Individual
TYRA LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
Mailing address
4311 ORCHARD PKWY, MUSKOGEE, OK 74403-8549
(918) 869-3152
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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