Healthcare Provider Details

I. General information

NPI: 1730009622
Provider Name (Legal Business Name): KATIE ELISABEH WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809B CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

IV. Provider business mailing address

111 JEANETTE AVE
CENTERVILLE OH
45458-2307
US

V. Phone/Fax

Practice location:
  • Phone: 513-360-8205
  • Fax: 513-620-5645
Mailing address:
  • Phone: 937-620-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2607977-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: