| Doctor Name: | JACQUELYN ANN WILSON |
| NPI Number: | 1326414947 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 91206 |
| Business Practice Address: | 402 W Morrow Rd Sand Springs, OK - 740636549 |
| Business Phone Number: | 9182451328 |
| Business Fax Number: | |
| Mailing Address: | 402 W Morrow Rd, SAND SPRINGS |
| State: | OK |
| Postal Code: | 740636549 |
| Phone Number: | 9187703134 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2015 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 91206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |