Individual
PREMA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1057205
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
1057205
TX
Other
Enumeration date
01/17/2022
Last updated
05/27/2022
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