Healthcare Provider Details

I. General information

NPI: 1437484706
Provider Name (Legal Business Name): KRISTIE L WILSON RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

15930 S GREAT OAKS DR
ROUND ROCK TX
78681-5800
US

IV. Provider business mailing address

15930 S GREAT OAKS DR
ROUND ROCK TX
78681-5800
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-8868
  • Fax: 512-255-8869
Mailing address:
  • Phone: 512-255-8868
  • Fax: 512-255-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number689938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: