| Doctor Name: | AMANDA WILSON |
| NPI Number: | 1003256496 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | A810519 |
| Business Practice Address: | 472 W Poplar Ave 101 Collierville, TN - 380172538 |
| Business Phone Number: | 9018545771 |
| Business Fax Number: | |
| Mailing Address: | Po Box 381071, GERMANTOWN |
| State: | TN |
| Postal Code: | 381831071 |
| Phone Number: | 9017545633 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2013 |
| NPI Last Update Date: | 08/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A810519 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |