Healthcare Provider Details

I. General information

NPI: 1467625889
Provider Name (Legal Business Name): KEVIN C WILSON ND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W MAIN ST SUITE C
HILLSBORO OR
97123-3967
US

IV. Provider business mailing address

328 W MAIN ST SUITE C
HILLSBORO OR
97123-3967
US

V. Phone/Fax

Practice location:
  • Phone: 503-648-0484
  • Fax: 503-681-9280
Mailing address:
  • Phone: 503-648-0484
  • Fax: 503-681-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number546
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number546
License Number StateOR

VIII. Authorized Official

Name: DR. KEVIN C WILSON
Title or Position: OWNER
Credential: ND
Phone: 503-648-0484