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NPI Code Detail

MEDICARE: KRISTIE JEAN WILSON

MEDICARE: KRISTIE JEAN WILSON
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
1171M00000XCase Manager/Care Coordinator
2101Y00000XCounselorC.1800944-TRNEOH

General Provider Information

NPI Number : 1811493372
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE JEAN WILSON
Provider Business Mailing Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-373-7848
Fax Number :
Provider Business Practice Location Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-373-7848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2018
Last Update Date : 06/17/2025

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Directions to “ KRISTIE JEAN WILSON ” Practice Location

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