Healthcare Provider Details

I. General information

NPI: 1275663940
Provider Name (Legal Business Name): KARLA D WILMOT RNC,WHNP,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S
INDEPENDENCE MO
64057-2303
US

IV. Provider business mailing address

19550 E 39TH ST S
INDEPENDENCE MO
64057-2303
US

V. Phone/Fax

Practice location:
  • Phone: 816-350-1200
  • Fax:
Mailing address:
  • Phone: 816-350-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number44963
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: