Provider Demographics
NPI:1154496040
Name:WILSON, JESSICA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:PARAGON BLDG STE 202
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2615
Mailing Address - Country:US
Mailing Address - Phone:340-776-5507
Mailing Address - Fax:340-776-7935
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON BLDG STE 202
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-776-5507
Practice Address - Fax:340-776-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2020-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA251287207R00000X, 208000000X
WI52351-20207R00000X, 208000000X
VISP1377208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1154496040Medicare UPIN