Provider Demographics
NPI:1477733319
Name:WILSON, PATRICK LEWIS (MMSC, MS, LCGC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:LEWIS
Last Name:WILSON
Suffix:
Gender:M
Credentials:MMSC, MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 NW 121ST TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8320
Mailing Address - Country:US
Mailing Address - Phone:405-271-5400
Mailing Address - Fax:405-271-5519
Practice Address - Street 1:1200 CHILDRENS AVE STE 1100
Practice Address - Street 2:PRENATAL DIAGNOSTIC CENTER, OUCPB
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-5400
Practice Address - Fax:405-271-5519
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS