NPI 1316698582

Carly Anne Wilson, PA

Practitioner Physician Assistant Raphine, VA

Practice location

Address: 25 Commerce Park Dr, Raphine, VA 24472-2547
Phone: (540) 490-2527
Mailing address: 40 Ball Diamond Trl, Vesuvius, VA 24483-2901

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 0110008398 (VA)

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Registry record

NPI: 1316698582
Entity type: Individual
Sex (as registered): Female
NPI issued: 10 Jan 2022
Record last updated: 14 Mar 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.