=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679423925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTEN HENAGE WILSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1924K DAUPHIN ISLAND PKWY
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36605-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-308-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 FOREST AVE
-----------------------------------------------------
City | SARALAND
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36571-9618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-513-0981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-164626
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------