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Individual

ALISHA CORA TARTER WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
30 MEDPARK SQUARE, SUITE 1, SOMERSET, KY 42503-3812
(606) 451-0485
(606) 451-0229
Mailing address
PO BOX 719, SOMERSET, KY 42502-0719
(606) 451-0485
(606) 451-0229

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1163
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA1163
KY LICENSE
KY
Enumeration date
01/09/2009
Last updated
01/28/2016
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