Individual
TATIANA VALERIEVNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3300 NW EXPRESSWAY, OKLAHOMA CITY, OK 73112-4418
(405) 945-5215
(405) 713-2794
Mailing address
1001 TERRACE RDG, NORMAN, OK 73026-0757
(405) 410-5183
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5225
OK
Other
Enumeration date
02/12/2024
Last updated
03/31/2024
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