Individual
TRACY DENISE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1911 MISSION 66 STE B, VICKSBURG, MS 39180-3762
(601) 665-4162
(855) 830-3484
Mailing address
4055 N PARK LOOP, MEMPHIS, TN 38152-4220
(901) 678-2003
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904985
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/25/2021
Last updated
04/19/2022
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