| Wilson Family Practice, Llc | |
|
899 Aigner Dr Boonville IN 47601-8473 | |
| (812) 641-0262 | |
| (812) 641-0557 |
| Full Name | Wilson Family Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 899 Aigner Dr, Boonville, Indiana |
| Authorized Official Name and Position | Michelle Lynn Wilson (OWNER) |
| Authorized Official Contact | 8126410262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Family Practice, Llc 899 Aigner Dr Boonville IN 47601-8473 Ph: (812) 641-0262 | Wilson Family Practice, Llc 899 Aigner Dr Boonville IN 47601-8473 Ph: (812) 641-0262 |
| NPI Number | 1588120547 |
|---|---|
| Provider Enumeration Date | 02/14/2019 |
| Last Update Date | 09/26/2019 |
| Medicare PECOS PAC ID | 5092055491 |
|---|---|
| Medicare Enrollment ID | O20190321002069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588120547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Michelle L Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982053385 PECOS PAC ID: 7012203516 Enrollment ID: I20160909000811 |
| Provider Name | Kimberly Tatum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619517513 PECOS PAC ID: 7911337050 Enrollment ID: I20200414000448 |
| Provider Name | Jacqueline Small |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265046585 PECOS PAC ID: 3274943287 Enrollment ID: I20201103001358 |
| Provider Name | Jennifer M Beckrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225781057 PECOS PAC ID: 0244624989 Enrollment ID: I20220223002141 |
| Provider Name | Lindsey M Cowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659089910 PECOS PAC ID: 9335518745 Enrollment ID: I20221207000665 |
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