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General NPI Number Information
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NPI Number | 1942397831
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Entity Type | Individual
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Provider Name | KELLY NICOLE WILSON RN
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1826 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3620
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Country | US
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Telephone | 478-272-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 MOUNT OLIVE RD
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City | IRWINTON
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State | GA
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Zip | 31042-2118
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Country | US
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Telephone | 478-272-1210
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN159391
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License Number State | GA
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