Provider Demographics
NPI:1720952922
Name:WILSON, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6066 MASON DIXON HWY
Mailing Address - Street 2:
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521-8310
Mailing Address - Country:US
Mailing Address - Phone:304-694-3240
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 198
Practice Address - Street 2:
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521-0198
Practice Address - Country:US
Practice Address - Phone:304-694-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker