Provider Demographics
NPI:1174140008
Name:WILSON, WILLIAM TIMOTHY (NP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TIMOTHY
Last Name:WILSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WILLIAMS ENTERPRISE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4224
Mailing Address - Country:US
Mailing Address - Phone:931-528-9222
Mailing Address - Fax:931-854-0907
Practice Address - Street 1:3300 WILLIAMS ENTERPRISE DR STE 1
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4280
Practice Address - Country:US
Practice Address - Phone:931-528-9222
Practice Address - Fax:931-854-0907
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN214850163WE0003X
TN28240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency