Individual
MR. JEREMY OREN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
700 S. MAIN, MOUNTAIN HOME, AR 72653-4445
(870) 425-1041
(870) 425-1049
Mailing address
1815 PLEASANT GROVE RD, JONESBORO, AR 72401-7870
(870) 933-6886
(870) 933-9395
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/27/2008
Last updated
12/08/2016
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