Provider Demographics
NPI:1114698974
Name:WILSON-EVERETT, PATRICIA ASHLEY (CPC-I)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ASHLEY
Last Name:WILSON-EVERETT
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 TERMINAL WAY STE 208B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2168
Mailing Address - Country:US
Mailing Address - Phone:775-322-3668
Mailing Address - Fax:
Practice Address - Street 1:1135 TERMINAL WAY STE 208B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2168
Practice Address - Country:US
Practice Address - Phone:775-322-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC15040101Y00000X
NVCP5680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor