Individual
AUTUMN NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
105 WALL STREET, POTEAU, OK 74953
(918) 635-3576
(918) 635-3332
Mailing address
105 WALL STREET, POTEAU, OK 74953
(918) 635-3576
(918) 635-3332
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209703
OK
Other
Enumeration date
03/31/2023
Last updated
03/28/2024
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