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NPI Code Detail

MEDICARE: KATRINA WILSON FNP

MEDICARE: KATRINA WILSON FNP
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
1363L00000XNurse PractitionerAPRN11001658FL
2363LF0000XFamily Nurse PractitionerAPRN11001658FL
3363L00000XNurse PractitionerGAA-NP001025GA
4363LF0000XFamily Nurse PractitionerGAA-NP001025GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336607522
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA WILSON FNP
Provider Business Mailing Address
First Line : 36 PEMBERTON CV
Second Line :
City : JACKSON
State : TN
Zip : 38305-5514
Country : US
Telephone Number : 731-394-1145
Fax Number :
Provider Business Practice Location Address
First Line : 3486 PEACH ORCHARD RD STE 200
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-5215
Country : US
Telephone Number : 706-828-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2019
Last Update Date : 09/19/2024

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Directions to “ KATRINA WILSON FNP” Practice Location

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