Healthcare Provider Details

I. General information

NPI: 1861213787
Provider Name (Legal Business Name): KALAY ROYALE WILSON PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N ALAFAYA TRL
ORLANDO FL
32826-2940
US

IV. Provider business mailing address

3157 N ALAFAYA TRL
ORLANDO FL
32826-2940
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-1360
  • Fax:
Mailing address:
  • Phone: 407-986-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025007015
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2084P0800X
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040508
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: