Provider Demographics
NPI:1902431885
Name:WILSON, NICHOLE PARKER (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:PARKER
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560G PARKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-8907
Mailing Address - Country:US
Mailing Address - Phone:919-398-1482
Mailing Address - Fax:
Practice Address - Street 1:101 N MARKET ST STE D300
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1514
Practice Address - Country:US
Practice Address - Phone:919-355-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF01200458363LF0000X
NC5013027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily