Individual
JAYMIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1705 E 19TH ST, STE 302, TULSA, OK 74104-5405
(918) 748-7585
Mailing address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 403-7054
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
99218
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99218
OKLAHOMA RN LICENSE
OK
Enumeration date
11/24/2015
Last updated
03/09/2016
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