Provider Demographics
NPI:1083158125
Name:WILSON, JOY (RN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 NEELY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRAY COURT
Mailing Address - State:SC
Mailing Address - Zip Code:29645-7462
Mailing Address - Country:US
Mailing Address - Phone:864-575-2126
Mailing Address - Fax:864-575-3428
Practice Address - Street 1:163 NEELY FERRY RD
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645-7462
Practice Address - Country:US
Practice Address - Phone:864-575-2126
Practice Address - Fax:864-575-3428
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse