Provider Demographics
NPI:1053069468
Name:WILSON, EMILIA ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILIA
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 E 155TH ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-9520
Mailing Address - Country:US
Mailing Address - Phone:816-803-0433
Mailing Address - Fax:
Practice Address - Street 1:242 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8642
Practice Address - Country:US
Practice Address - Phone:816-803-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015019799363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care