| Provider / Organization | NPI | Date Certified |
|---|---|---|
| GRACE MARY WILSON | 1275356248 | 2024-11-10 |
Grace Mary Wilson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1275356248. Registration indicates Grace Mary Wilson is a provider of access to mental health/behavioral health providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Psych/Mental Health, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Psych/Mental Health, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Grace Mary Wilson PMHNP-BC |
| Practice Office Address | 1168 SUPERBLOOM AVE JUSTIN, TX US |
| Practice Office Telephone | 8178323731 |
| Mailing Address | 1168 SUPERBLOOM AVE JUSTIN, TX 762472096 US |
| Business Telephone | 8178323731 |
| Code | Practice | License No State |
|---|---|---|
| 363LP0808X PRIMARY | Access to Mental Health/Behavioral Health Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Psych/Mental Health All Other Specialties & Provider Types Nurse Practitioner Psych/Mental Health Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 1178385
TX |