Individual
JENNIFER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 561-1131
(918) 561-1140
Mailing address
5610 E 31ST ST FL 13, TULSA, OK 74135-5018
(918) 561-5701
(918) 561-1173
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
5681
OK
207Q00000X
Family Medicine Physician
5681
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200589190A
—
OK
01
—
413203YM2Y
MEDICARE
OK
Enumeration date
07/10/2012
Last updated
01/19/2023
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