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General NPI Number Information
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NPI Number | 1538255344
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Entity Type | Individual
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Provider Name | KELLY E WILSON
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7400 FANNIN SUITE 930
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City | HOUSTON
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State | TX
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Zip | 77054
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Country | US
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Telephone | 713-796-8200
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Fax | 713-796-8203
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Provider Business Mailing Address
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Address Line | 6448 BROMPTON
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City | HOUSTON
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State | TX
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Zip | 77055
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Country | US
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Telephone | 713-839-0581
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | J9443
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License Number State | TX
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