Victoria Nichole Wilson
Individual provider Active NPI Community Health Worker · Logansport, LA
NPI 1730849852 · NPPES record last updated Dec 30, 2021
Key facts
- NPI
- 1730849852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 1409 Jacqualine Street
Logansport, LA 71049 - Phone
- (318) 575-9018
- NPI assigned
- Dec 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | LA | Yes |
Addresses
Primary practice location
1409 Jacqualine Street
Logansport, LA 71049
Mailing address
PO Box 1041
Logansport, LA 71049-1041
Phone (318) 575-9018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3247 | Medicaid | LA |
Other providers in Logansport, LA
- Melissa Sistrunk Richardson
- Octavia Paulette Richardson
- Felicia W Ross
- Shomichael Stephens
- Robert Edwin Toner III
- Francie Louann Woods
All providers in Logansport, LA · Community Health Worker in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.