Provider Demographics
NPI:1073909883
Name:WILSON, JEFFREY LYNN (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:LYNN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5516 BARONS PT
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8875
Mailing Address - Country:US
Mailing Address - Phone:423-987-5333
Mailing Address - Fax:
Practice Address - Street 1:5516 BARONS PT
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8875
Practice Address - Country:US
Practice Address - Phone:423-987-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19891364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health