Individual
TIFFANY MICHELLE LADONNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3575 KEITH ST NW STE 205, CLEVELAND, TN 37312-4326
(423) 559-0444
Mailing address
3575 KEITH ST NW STE 205, CLEVELAND, TN 37312-4326
(423) 559-0444
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2966
TN
2255A2300X
Athletic Trainer
—
OH
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
06/08/2020
Last updated
08/24/2022
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