Individual
HOLLY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
800 HOSPITAL DR, COLUMBIA, MO 65201-5275
(573) 814-6000
Mailing address
919 COUNTRY RIDGE DR, JEFFERSON CITY, MO 65109-5738
(573) 690-3390
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110002870
VA
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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