Provider Demographics
NPI:1336515907
Name:WILSON, JER'DONNA DOWNESHA (CRNP)
Entity Type:Individual
Prefix:
First Name:JER'DONNA
Middle Name:DOWNESHA
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CRUZ CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36110-3236
Mailing Address - Country:US
Mailing Address - Phone:334-202-3505
Mailing Address - Fax:
Practice Address - Street 1:1965 COBBS FORD RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7290
Practice Address - Country:US
Practice Address - Phone:334-323-1330
Practice Address - Fax:334-361-8750
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily