MEDICARE: MRS. KAYLA WILSON CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	112392-23	NH
2	163W00000X	Registered Nurse	112392-21	NH

General Provider Information

NPI Number	:	1063055663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLA WILSON CPNP-PC

Provider Business Mailing Address
First Line	:	3 JEFFERSON DR
Second Line	:
City	:	LONDONDERRY
State	:	NH
Zip	:	03053-3647
Country	:	US
Telephone Number	:	508-410-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COUNTRY CLUB RD UNIT 703
Second Line	:
City	:	GILFORD
State	:	NH
Zip	:	03249-6977
Country	:	US
Telephone Number	:	603-409-6187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	01/15/2026

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