Provider Demographics
NPI:1235936212
Name:WILSON, STEPHANIE RENEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:BATSON
Mailing Address - State:TX
Mailing Address - Zip Code:77519-0104
Mailing Address - Country:US
Mailing Address - Phone:936-253-9201
Mailing Address - Fax:
Practice Address - Street 1:43949 HWY 105
Practice Address - Street 2:
Practice Address - City:HULLL
Practice Address - State:TX
Practice Address - Zip Code:77564
Practice Address - Country:US
Practice Address - Phone:936-253-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty