Healthcare Provider Details

I. General information

NPI: 1578543740
Provider Name (Legal Business Name): KAREN WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN WILSON MD

II. Dates (important events)

Enumeration Date: 01/22/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 VALLEYGATE DR STE 103
FAYETTEVILLE NC
28304-3571
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3590
  • Fax: 910-435-0936
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number24057
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2013-02311
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number208D00000X
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013-02311
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101276030
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101276030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: