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General NPI Number Information
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NPI Number | 1952116196
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Entity Type | Individual
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Provider Name | KETTIA WILSON MSN NC-BC RN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 15460 CANYON GULCH LN UNIT 210
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4705
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Country | US
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Telephone | 303-901-9163
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Fax |
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Provider Business Mailing Address
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Address Line | 15460 CANYON GULCH LN UNIT 210
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4705
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Country | US
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Telephone | 303-901-9163
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | RN.1632281
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License Number State | CO
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