Provider Demographics
NPI:1013788595
Name:WILSON, EMMA LUCILLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LUCILLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 LAMBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2450
Mailing Address - Country:US
Mailing Address - Phone:614-288-1890
Mailing Address - Fax:614-785-0095
Practice Address - Street 1:1035 PROPRIETORS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3284
Practice Address - Country:US
Practice Address - Phone:614-785-1115
Practice Address - Fax:614-785-0095
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0039426363LP0808X
OHRN.464250163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult