Individual
MRS. STEPHANIE RACHEL WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1720 E REELFOOT AVE, STE 104 A, UNION CITY, TN 38261
(731) 885-8484
(731) 884-1609
Mailing address
1720 E REEFOOT AVENUE, SUITE 104A, UNION CITY, TN 38261
(731) 885-8484
(731) 884-1609
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1394
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3664494
—
TN
Enumeration date
07/17/2006
Last updated
04/26/2017
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