Individual
THOMAS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2501 KENTUCKY AVE, PADUCAH, KY 42003-3813
(270) 575-2100
Mailing address
1925 S 25TH ST, PADUCAH, KY 42003-2948
(706) 975-4182
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4049423
KY
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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