Provider Demographics
NPI:1306320296
Name:WILSON, PAULA MARY
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARY
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 RED BUD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2348
Mailing Address - Country:US
Mailing Address - Phone:254-913-3192
Mailing Address - Fax:
Practice Address - Street 1:3410 RED BUD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2348
Practice Address - Country:US
Practice Address - Phone:254-913-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator