Healthcare Provider Details

I. General information

NPI: 1659580371
Provider Name (Legal Business Name): KATHERINE B WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BELMONT BLVD
NASHVILLE TN
37212-3758
US

IV. Provider business mailing address

4104A SNEED RD
NASHVILLE TN
37215-2304
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-5534
  • Fax: 615-460-6131
Mailing address:
  • Phone: 615-269-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000005182
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: