Provider Demographics
NPI:1750097242
Name:WILSON, BARBARA MOORE (NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MOORE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:HOUCHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639972
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22708 MAIN ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:VA
Practice Address - Zip Code:23837-1127
Practice Address - Country:US
Practice Address - Phone:757-653-2007
Practice Address - Fax:757-935-5551
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner