Provider Demographics
NPI:1891946695
Name:WILSON, MEGAN BRIANA (BSE)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BRIANA
Last Name:WILSON
Suffix:
Gender:F
Credentials:BSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5820
Mailing Address - Country:US
Mailing Address - Phone:870-236-5880
Mailing Address - Fax:870-236-5757
Practice Address - Street 1:1715 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5820
Practice Address - Country:US
Practice Address - Phone:870-236-5880
Practice Address - Fax:870-236-5757
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator