Provider Demographics
NPI:1417161290
Name:WILSON, ALICIA K
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 COUNTY RD 6
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:740-533-0076
Mailing Address - Fax:740-643-0935
Practice Address - Street 1:1035 COUNTRY RD 1
Practice Address - Street 2:APT 253
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:740-377-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2559208OtherODJFS