Provider Demographics
NPI:1982063988
Name:WILSON, JENNIFER SUZETTE (ARNP (PMHNP))
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP (PMHNP)
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUZETTE
Other - Last Name:BYARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:206 RESCIA AVE
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5933
Mailing Address - Country:US
Mailing Address - Phone:256-413-7154
Mailing Address - Fax:
Practice Address - Street 1:206 RESCIA AVE
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5933
Practice Address - Country:US
Practice Address - Phone:256-413-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9394055363LP0808X
AL1-076818 CRNP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health