Provider Demographics
NPI:1093422636
Name:WILSON, JESSICA LANEICE (BHRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LANEICE
Last Name:WILSON
Suffix:
Gender:
Credentials:BHRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LANEICE
Other - Last Name:JEFFERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-8901
Mailing Address - Fax:907-729-6353
Practice Address - Street 1:3851 PIPER ST STE U464
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6905
Practice Address - Country:US
Practice Address - Phone:907-339-0363
Practice Address - Fax:907-339-2363
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK117979163WA0400X
AK236190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)