Provider Demographics
NPI:1083356992
Name:WILSON, DAVID ARTHUR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1371
Mailing Address - Country:US
Mailing Address - Phone:606-356-5926
Mailing Address - Fax:
Practice Address - Street 1:314 FERRY ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1371
Practice Address - Country:US
Practice Address - Phone:606-356-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator