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NPI Code Detail

MEDICARE: MS. KATHERINE LYNN WILSON PA-C

MEDICARE: MS. KATHERINE LYNN WILSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-16617NC

General Provider Information

NPI Number : 1013849793
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHERINE LYNN WILSON PA-C
Provider Business Mailing Address
First Line : 1025 MOREHEAD MEDICAL DR STE 600
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2969
Country : US
Telephone Number : 704-355-6649
Fax Number : 704-446-4876
Provider Business Practice Location Address
First Line : 1025 MOREHEAD MEDICAL DR STE 600
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2969
Country : US
Telephone Number : 704-355-6649
Fax Number : 704-446-4876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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