Individual
STACEY LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
226 MADISON 7875, WESLEY, AR 72773
(479) 790-9308
Mailing address
226 MADISON 7875, WESLEY, AR 72773-8615
(479) 790-9308
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2017006269
AR
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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