Provider Demographics
NPI:1518697796
Name:WILSON, JEKERA YASHONDA Y'SATIS (DOULA)
Entity Type:Individual
Prefix:
First Name:JEKERA
Middle Name:YASHONDA Y'SATIS
Last Name:WILSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N IOWA AVE # C18
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1782
Mailing Address - Country:US
Mailing Address - Phone:407-970-0966
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR # 2019
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:407-970-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula