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General NPI Number Information
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NPI Number | 1285826057
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Entity Type | Individual
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Provider Name | KIMBERLY ELLISON WILSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1325 MCFARLAND BLVD SUITE 104
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City | NORTHPORT
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State | AL
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Zip | 35476-3270
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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Provider Business Mailing Address
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Address Line | 1325 MCFARLAND BLVD SUITE 104
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City | NORTHPORT
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State | AL
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Zip | 35476-3270
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-078924
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License Number State | AL
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