Individual
BLAKE LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2001 CRADDUCK RD, ADA, OK 74820-9400
(405) 514-4786
(405) 758-5582
Mailing address
1813 S 14TH ST, MCALESTER, OK 74501-7220
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
89530
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200454040A
—
OK
Enumeration date
09/14/2012
Last updated
08/13/2025
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