Provider Information for 1972926673
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JANA WILSON B.S. MHP
Sex: Female
NPI: 1972926673
Last Updated: 2021-09-03
Certification Date: 2021-09-03
Certification Date: 2021-09-03
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972926673 | ||||||||||||
| Enumeration Date | 2014-01-31 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 701 PADUCAH, KY 42002-0701 United States Phone: 270-816-2671 | Fax: | ||||||||||||
| Primary Practice Address | 560 OAKLAND CIR PADUCAH, KY 42003-8924 United States Phone: 127-081-6267 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 206 W 5TH ST 425 BROADWAY ST | ||||||||||||
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