Individual
JAQUELL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8014 MIDLOTHIAN TPKE STE 318, NORTH CHESTERFIELD, VA 23235-5291
(804) 866-7050
Mailing address
4807 TOOLEY DR, CHESTER, VA 23831-6631
(434) 480-6111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001301085
VA
163WH0200X
Home Health Registered Nurse
0001301085
VA
342000000X
Transportation Network Company
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
06/01/2022
Last updated
05/12/2025
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