Provider Demographics
NPI:1831616853
Name:WILSON, ALICIA MARIE (DMSC, PA-C)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMSC, PA-C
Other - Prefix:
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Mailing Address - Street 1:3966 JESSE RUN RD
Mailing Address - Street 2:
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-8230
Mailing Address - Country:US
Mailing Address - Phone:304-884-2404
Mailing Address - Fax:
Practice Address - Street 1:201 FCI LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-9500
Practice Address - Country:US
Practice Address - Phone:304-626-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2020-09-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical