Provider Demographics
NPI:1144469644
Name:WILSON, WILLIAM JARRETT (APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JARRETT
Last Name:WILSON
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4106
Mailing Address - Country:US
Mailing Address - Phone:916-547-8158
Mailing Address - Fax:866-390-0008
Practice Address - Street 1:406 SUNRISE AVE STE 330
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4106
Practice Address - Country:US
Practice Address - Phone:916-547-8158
Practice Address - Fax:866-390-0008
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2023-02-08
Deactivation Date:2019-10-02
Deactivation Code:
Reactivation Date:2019-10-10
Provider Licenses
StateLicense IDTaxonomies
CA849311163WE0003X
CA95011839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency