Provider Demographics
NPI:1336781657
Name:J WILSON HEALTH LLC
Entity Type:Organization
Organization Name:J WILSON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C
Authorized Official - Phone:901-235-0957
Mailing Address - Street 1:5100 POPLAR AVE
Mailing Address - Street 2:FL 27 STE 2719A
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38137-2701
Mailing Address - Country:US
Mailing Address - Phone:901-235-0957
Mailing Address - Fax:
Practice Address - Street 1:5100 POPLAR AVE, FL 27 STE 2719A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38137-2701
Practice Address - Country:US
Practice Address - Phone:901-235-0957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty