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NPI Code Detail

MEDICARE: DR. KRISTEN E WILSON PH.D.

MEDICARE: DR. KRISTEN E WILSON PH.D.
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
1103TC0700XClinical Psychologist33834TX

General Provider Information

NPI Number : 1235779497
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN E WILSON PH.D.
Provider Business Mailing Address
First Line : 2237 RIDGE RD STE 101
Second Line :
City : ROCKWALL
State : TX
Zip : 75087-5161
Country : US
Telephone Number : 972-771-3969
Fax Number : 972-771-8258
Provider Business Practice Location Address
First Line : 2237 RIDGE RD STE 101
Second Line :
City : ROCKWALL
State : TX
Zip : 75087-5161
Country : US
Telephone Number : 972-771-3969
Fax Number : 972-771-8258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2020
Last Update Date : 01/15/2020

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