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General NPI Number Information
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NPI Number | 1245247428
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Entity Type | Individual
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Provider Name | CAROLYN ANN WILSON C.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 14001 HIGHWAY 43 STE 24
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2849
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Country | US
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Telephone | 256-398-7212
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 HIGHWAY 43 STE 24
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2849
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Country | US
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Telephone | 256-356-9537
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Fax | 256-359-2315
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-047836
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License Number State | AL
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