Provider Demographics
NPI:1073674347
Name:WILSON, ERMA JEAN (GNP)
Entity Type:Individual
Prefix:DR
First Name:ERMA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W WHEELER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4536
Mailing Address - Country:US
Mailing Address - Phone:361-887-9600
Mailing Address - Fax:361-883-1661
Practice Address - Street 1:1711 W WHEELER AVE STE 2
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-887-9600
Practice Address - Fax:361-883-1661
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0105241-23363LG0600X
TX223581363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171346301Medicaid
TX8C0058Medicare PIN
TX171346301Medicaid