Provider Demographics
NPI:1861768665
Name:WILSON, STEPHEN CHRISTOPHER (PNP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:WILSON
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 HIGHWAY 51 NORTH
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-873-4242
Mailing Address - Fax:901-873-4269
Practice Address - Street 1:8222 HIGHWAY 51 NORTH
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-873-4242
Practice Address - Fax:901-873-4269
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16598363L00000X
TNAPN016598363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530867Medicaid