Individual
RAEGAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
897856
MS
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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