Individual
KEADREA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 UNION AVE STE 700, MEMPHIS, TN 38104-3641
(214) 456-2735
Mailing address
1407 UNION AVE STE 700, MEMPHIS, TN 38104-3641
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
0000057291
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2015
Last updated
07/15/2021
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