Individual
MR. ZACHARY SCOTT WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGAC-NP
Contact information
Practice address
1453 E BERT KOUN LOOP STE 112, SHREVEPORT, LA 71105-6810
(318) 223-5777
Mailing address
1453 E BERT KOUN LOOP STE 112, SHREVEPORT, LA 71105-6810
(318) 223-5777
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
226165
LA
Other
Enumeration date
06/18/2022
Last updated
06/22/2022
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