Provider Demographics
NPI:1538552526
Name:WILSON, JENNIFER LOUISE (MS, ATC,)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, ATC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KEDRON PKWY
Mailing Address - Street 2:280N
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2462
Mailing Address - Country:US
Mailing Address - Phone:931-217-1749
Mailing Address - Fax:
Practice Address - Street 1:119 SEABOARD LN
Practice Address - Street 2:STE. 401
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8306
Practice Address - Country:US
Practice Address - Phone:615-915-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer