MEDICARE: MRS. RACHEL KELT WILSON M.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
1	208000000X	Pediatrics Physician	R6806	TX

General Provider Information

NPI Number	:	1497142418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL KELT WILSON M.D.

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR STE 1.100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 2445
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-704-0669
Fax Number	:

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	09/25/2024

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