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General NPI Number Information
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NPI Number | 1679728026
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Entity Type | Individual
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Provider Name | KATHLEEN P. WILSON PHD,CPNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2008
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | FSU HEALTH LIFESTYLE MEDICINE CLINIC 1630 RIGGINS ROAD
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-878-4434
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Fax | 949-655-8526
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Provider Business Mailing Address
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Address Line | FSU HEALTH LIFESTYLE MEDICINE CLINIC 1630 RIGGINS ROAD
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-878-4434
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Fax | 949-655-8526
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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 | ARNP 1018702
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License Number State | FL
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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 | ARNP 1018702
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License Number State | FL
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