Healthcare Provider Details

I. General information

NPI: 1679879688
Provider Name (Legal Business Name): KAYEE VERONICA WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 ANNAPOLIS RD
NEW CARROLLTON MD
20784-3016
US

IV. Provider business mailing address

8201 ANNAPOLIS RD
NEW CARROLLTON MD
20784-3016
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-6222
  • Fax:
Mailing address:
  • Phone: 301-577-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR189585
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR189585
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR189585
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: