Individual
REGAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6000
(417) 269-0500
Mailing address
PO BOX 505673, SAINT LOUIS, MO 63150-5673
(417) 730-6430
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024001733
MO
Other
Enumeration date
01/17/2024
Last updated
04/15/2024
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