Individual
NIKKI RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6663
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 364-4200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1106348
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020014289
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100062540
—
KY
Enumeration date
08/27/2008
Last updated
07/11/2022
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