Provider Demographics
NPI:1114717691
Name:WILSON, JAMES LAURENCE (LVN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LAURENCE
Last Name:WILSON
Suffix:
Gender:
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAUREL WAY APT B
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7053
Mailing Address - Country:US
Mailing Address - Phone:830-739-9200
Mailing Address - Fax:
Practice Address - Street 1:113 LAUREL WAY APT B
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-7053
Practice Address - Country:US
Practice Address - Phone:830-739-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219323164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse