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NPI Code Detail

MEDICARE: KRISTINA MARIE WILSON FNP

MEDICARE: KRISTINA MARIE 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 Practitioner201384NC

General Provider Information

NPI Number : 1942209499
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA MARIE WILSON FNP
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 123 PROFESSIONAL PARK DR
Second Line :
City : LOCUST
State : NC
Zip : 28097-7712
Country : US
Telephone Number : 704-403-6760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 09/25/2025

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Directions to “ KRISTINA MARIE WILSON FNP” Practice Location

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