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General NPI Number Information
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NPI Number | 1295337541
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Entity Type | Individual
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Provider Name | CRYSTAL ANN WILSON APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 4604 US HIGHWAY 60 W
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City | MORGANFIELD
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State | KY
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Zip | 42437-6515
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Country | US
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Telephone | 270-389-5054
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Fax | 270-389-5094
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Provider Business Mailing Address
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Address Line | 4604 US HIGHWAY 60 W
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City | MORGANFIELD
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State | KY
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Zip | 42437-6515
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Country | US
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Telephone | 270-389-5000
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Fax |
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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 | 28228168A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3015121
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License Number State | KY
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