Provider Demographics
NPI:1538721501
Name:WILSON, MEGAN LORRAINE (NP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LORRAINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:LORRAINE
Other - Last Name:MASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2340 KNOB CREEK RD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-926-6112
Mailing Address - Fax:423-434-0278
Practice Address - Street 1:2340 KNOB CREEK RD
Practice Address - Street 2:SUITE 720
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-926-6112
Practice Address - Fax:423-434-0278
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily