Provider Demographics
NPI:1306806328
Name:WILSON, DENA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:WHITEWRIGHT
Mailing Address - State:TX
Mailing Address - Zip Code:75491-0423
Mailing Address - Country:US
Mailing Address - Phone:903-583-6500
Mailing Address - Fax:903-583-6625
Practice Address - Street 1:1201 E 9TH ST
Practice Address - Street 2:NHCU
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4059
Practice Address - Country:US
Practice Address - Phone:903-583-6500
Practice Address - Fax:903-583-6625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant