Provider Demographics
NPI:1598256869
Name:WILSON, JENNA LYNN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 LINCOLN SQ
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4857
Mailing Address - Country:US
Mailing Address - Phone:817-277-3469
Mailing Address - Fax:817-277-9309
Practice Address - Street 1:716 LINCOLN SQ
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:817-277-3469
Practice Address - Fax:817-277-9309
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily