Individual
JACKILYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3120 GOVERNORS PLACE BLVD, DAYTON, OH 45409-1328
(937) 293-1622
(937) 245-6308
Mailing address
400 SUGAR CAMP CIR, STE 200, OAKWOOD, OH 45409-1981
(937) 276-8320
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
019508
OH
363LA2100X
Acute Care Nurse Practitioner
RN328660
OH
Other
Enumeration date
07/25/2016
Last updated
11/11/2021
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