Healthcare Provider Details

I. General information

NPI: 1255755997
Provider Name (Legal Business Name): KENDRA MARIE WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 W CORTARO FARMS RD STE 157
TUCSON AZ
85742-8683
US

IV. Provider business mailing address

3605 W CORTARO FARMS RD STE 157
TUCSON AZ
85742-8683
US

V. Phone/Fax

Practice location:
  • Phone: 520-333-5902
  • Fax: 520-666-3233
Mailing address:
  • Phone: 520-333-5902
  • Fax: 520-666-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5411
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN144375
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: