Provider Demographics
NPI:1861213787
Name:WILSON, DEWONA KALAY
Entity type:Individual
Prefix:
First Name:DEWONA
Middle Name:KALAY
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 1:4906 ROYAL STABLE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2440
Mailing Address - Country:US
Mailing Address - Phone:210-780-9973
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4906 ROYAL STABLE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2440
Practice Address - Country:US
Practice Address - Phone:210-780-9973
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2084P0800X163WP0808X
TX2025007015363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health