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NPI Code Detail

MEDICARE: KATHY A. WILSON ARNP

MEDICARE: KATHY A. WILSON ARNP
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
1363L00000XNurse PractitionerARNP9162558FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174508915
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY A. WILSON ARNP
Provider Business Mailing Address
First Line : 151 MARY ESTHER BLVD
Second Line : STE 408
City : MARY ESTHER
State : FL
Zip : 32569-1975
Country : US
Telephone Number : 850-863-3000
Fax Number : 850-862-1621
Provider Business Practice Location Address
First Line : 2010 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1352
Country : US
Telephone Number : 850-863-3000
Fax Number : 850-862-1621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 09/12/2017

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