MEDICARE: MS. KATHERINE B 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	363LP2300X	Primary Care Nurse Practitioner	APN0000005182	TN

General Provider Information

NPI Number	:	1659580371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE B WILSON FNP

Provider Business Mailing Address
First Line	:	4104A SNEED RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2304
Country	:	US
Telephone Number	:	615-269-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BELMONT BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3758
Country	:	US
Telephone Number	:	615-460-5534
Fax Number	:	615-460-6131

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	10/08/2009

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