Individual
JESSICA ANNE WILDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2551 GREENWOOD RD STE 320, SHREVEPORT, LA 71103-3989
(182) 127-1763
(318) 212-8186
Mailing address
2551 GREENWOOD RD STE 320, SHREVEPORT, LA 71103-3989
(318) 212-8176
(318) 212-8186
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD.206396
LA
207T00000X
Neurological Surgery Physician
MT186916
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2342053
—
LA
Enumeration date
12/19/2006
Last updated
06/17/2021
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