# KATHY LYNN WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750158507
- **Gender:** F
- **Credential:** PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 2023047220 | MO | Yes |

## Other

- **Enumeration date:** 12/11/2023
- **Last updated:** 09/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 420136965 | — | MO |