Provider Demographics
NPI:1386424208
Name:WILSON, ALLISON THERIOT (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:THERIOT
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LUXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-4509
Mailing Address - Country:US
Mailing Address - Phone:337-251-1824
Mailing Address - Fax:
Practice Address - Street 1:153 TOWN BLVD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6971
Practice Address - Country:US
Practice Address - Phone:337-942-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily