Individual
STAR J WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1014 JOHNNY RUSSELL DRIVE, MOORHEAD, MS 38761
(662) 378-7508
Mailing address
PO BOX 36, MOORHEAD, MS 38761-0036
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
923940
MS
Other
Enumeration date
08/28/2024
Last updated
09/11/2025
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