Provider Demographics
NPI:1366688301
Name:ADDISON, MARGUERITE WILSON (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:WILSON
Last Name:ADDISON
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:MRS
Other - First Name:MARGUERITE 'PEGGY'
Other - Middle Name:W
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, PMHNP
Mailing Address - Street 1:8414 OLD MCGREGOR RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6496
Mailing Address - Country:US
Mailing Address - Phone:254-294-2887
Mailing Address - Fax:254-233-8878
Practice Address - Street 1:8414 OLD MCGREGOR RD UNIT B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6496
Practice Address - Country:US
Practice Address - Phone:254-294-2887
Practice Address - Fax:254-233-8878
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX428836363LP0808X
TXAPN117279363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health