Provider Demographics
NPI:1043609670
Name:WILSON, ANNE TATE (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:TATE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FITNESS WAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2480
Mailing Address - Country:US
Mailing Address - Phone:256-232-0636
Mailing Address - Fax:256-232-1281
Practice Address - Street 1:101 FITNESS WAY
Practice Address - Street 2:SUITE 1200
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2480
Practice Address - Country:US
Practice Address - Phone:256-232-0636
Practice Address - Fax:256-232-1281
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037745363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care