Provider Demographics
NPI:1265678858
Name:WILSON, CATHERINE S (ACNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-396-4694
Mailing Address - Fax:615-396-6751
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3837
Practice Address - Country:US
Practice Address - Phone:615-396-4694
Practice Address - Fax:615-396-6751
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
5857OtherLICENSE NUMBER