MEDICARE: KATHY MAE 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
1	207Q00000X	Family Medicine Physician	11046624	FL

General Provider Information

NPI Number	:	1326980384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY MAE WILSON ARNP

Provider Business Mailing Address
First Line	:	1010 W LEADER CT
Second Line	:
City	:	LABELLE
State	:	FL
Zip	:	33935-4737
Country	:	US
Telephone Number	:	239-848-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	8960 COLONIAL CENTER DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7810
Country	:	US
Telephone Number	:	239-343-9400
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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