Provider Demographics
NPI:1043931876
Name:WILSON, TOSHA LUCILLE
Entity Type:Individual
Prefix:DR
First Name:TOSHA
Middle Name:LUCILLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BETTER NOW PLZ
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2279
Mailing Address - Country:US
Mailing Address - Phone:580-310-9989
Mailing Address - Fax:
Practice Address - Street 1:709 BETTER NOW PLZ
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2279
Practice Address - Country:US
Practice Address - Phone:580-310-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily