Provider Demographics
NPI:1275194060
Name:WILSON, NANCY MICHELLE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3952
Mailing Address - Country:US
Mailing Address - Phone:870-460-9889
Mailing Address - Fax:870-460-9887
Practice Address - Street 1:127 N PARK DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-3952
Practice Address - Country:US
Practice Address - Phone:870-460-9889
Practice Address - Fax:870-460-9887
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR653237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist