Individual
MINDY SMITH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1404 TONEY DR SE, HUNTSVILLE, AL 35802-1231
(859) 608-8890
Mailing address
1404 TONEY DR SE, HUNTSVILLE, AL 35802-1231
(859) 608-8890
(859) 608-8890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA996
KY
363AM0700X
Medical Physician Assistant
Primary
758
AL
363AM0700X
Medical Physician Assistant
PA996
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
Enumeration date
10/03/2006
Last updated
07/08/2011
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