Individual
JESSICA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4613 W MAIN ST, SUITE A, KALAMAZOO, MI 49006-2645
(269) 488-8672
(269) 488-8673
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 488-8672
(269) 488-8673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004667
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1153911890
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/31/2006
Last updated
03/29/2023
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