Provider Demographics
NPI:1760600944
Name:WASSON, MOLLY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANN
Last Name:WASSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BAYOU ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1034
Mailing Address - Country:US
Mailing Address - Phone:812-886-6800
Mailing Address - Fax:812-886-6809
Practice Address - Street 1:1901 WILLOW ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4277
Practice Address - Country:US
Practice Address - Phone:812-885-2720
Practice Address - Fax:812-885-2723
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001744A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200487680AMedicaid
IN000000339486OtherBCBS
IN444530028Medicare PIN
INQ19747Medicare UPIN
IN000000339486OtherBCBS