Healthcare Provider Details

I. General information

NPI: 1124151246
Provider Name (Legal Business Name): KRISTIN METCALF-WILSON RN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N PROVIDENCE RD
COLUMBIA MO
65203-4357
US

IV. Provider business mailing address

4401 W 109TH ST SUITE 200
OVERLAND PARK KS
66211-1303
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-0427
  • Fax:
Mailing address:
  • Phone: 913-312-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number147494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: