MEDICARE: DR. KENDRA MARIE WILSON FNP

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
1	163WG0000X	General Practice Registered Nurse	RN144375	AZ
2	363LF0000X	Family Nurse Practitioner	AP5411	AZ

General Provider Information

NPI Number	:	1255755997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDRA MARIE WILSON FNP

Provider Business Mailing Address
First Line	:	3605 W CORTARO FARMS RD STE 157
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8683
Country	:	US
Telephone Number	:	520-333-5902
Fax Number	:	520-666-3233

Provider Business Practice Location Address
First Line	:	3605 W CORTARO FARMS RD STE 157
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8683
Country	:	US
Telephone Number	:	520-333-5902
Fax Number	:	520-666-3233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	01/12/2026

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