Healthcare Provider Details

I. General information

NPI: 1083256465
Provider Name (Legal Business Name): CHRISTI L. WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 INDUSTRIAL DR W
PINE HILL AL
36769-3369
US

IV. Provider business mailing address

6 WILSON DR
CAMDEN AL
36726-1835
US

V. Phone/Fax

Practice location:
  • Phone: 334-963-2113
  • Fax: 334-963-2116
Mailing address:
  • Phone: 52-913-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-121650
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-121650
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: