Provider Demographics
NPI:1225748437
Name:WILSON, ADRIENNE LYNN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 JAMESTOWN LN
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5118
Mailing Address - Country:US
Mailing Address - Phone:469-586-8273
Mailing Address - Fax:
Practice Address - Street 1:3206 INTERSTATE 30 WEST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-408-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily