MEDICARE: KATHERINE LEE WILSON MS

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1922750298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LEE WILSON MS

Provider Business Mailing Address
First Line	:	1021 MOREHEAD MEDICAL DR STE 2300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2991
Country	:	US
Telephone Number	:	980-442-2516
Fax Number	:	980-442-2526

Provider Business Practice Location Address
First Line	:	1021 MOREHEAD MEDICAL DR STE 2300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2991
Country	:	US
Telephone Number	:	980-442-2516
Fax Number	:	980-442-2526

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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