Provider Demographics
NPI:1215439203
Name:WILSON, WILLIAM EVAN I (PMHNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EVAN
Last Name:WILSON
Suffix:I
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 INDEPENDENCE LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3073
Mailing Address - Country:US
Mailing Address - Phone:423-562-1705
Mailing Address - Fax:
Practice Address - Street 1:130 INDEPENDENCE LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3073
Practice Address - Country:US
Practice Address - Phone:423-562-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health