Healthcare Provider Details

I. General information

NPI: 1851777825
Provider Name (Legal Business Name): KATHRYN T. WILSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 S HIGHWAY 27 STE 1
SOMERSET KY
42501-3073
US

IV. Provider business mailing address

PO BOX 306
FERGUSON KY
42533-0306
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-4551
  • Fax: 606-678-0972
Mailing address:
  • Phone: 606-492-2211
  • Fax: 606-676-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1996DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: