Individual
MYLA MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2707 BROWNS LN, JONESBORO, AR 72401-7213
(870) 972-4050
(479) 750-4843
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 725-5115
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R069093
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173783795
—
AR
Enumeration date
04/23/2007
Last updated
03/24/2020
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