MEDICARE: KRISTEN BROOKE WILSON APRN

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	363LF0000X	Family Nurse Practitioner	40137	TN
2	363LF0000X	Family Nurse Practitioner	4011810	KY

General Provider Information

NPI Number	:	1437923430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN BROOKE WILSON APRN

Provider Business Mailing Address
First Line	:	3231 GREENVILLE RD
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-7240
Country	:	US
Telephone Number	:	270-985-3028
Fax Number	:

Provider Business Practice Location Address
First Line	:	10755 EAGLE WAY
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-8742
Country	:	US
Telephone Number	:	270-887-0280
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	12/23/2025

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