Provider Demographics
NPI:1902525009
Name:WILSON, TROYNECIA BRENEE
Entity Type:Individual
Prefix:
First Name:TROYNECIA
Middle Name:BRENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ISLAND PARK BLVD APT 1007
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4777
Mailing Address - Country:US
Mailing Address - Phone:318-401-7632
Mailing Address - Fax:
Practice Address - Street 1:1105 ISLAND PARK BLVD APT 1007
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4777
Practice Address - Country:US
Practice Address - Phone:318-401-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator