# KASSI LEE WILSON

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

## Provider details

- **NPI number:** 1871163170
- **Gender:** F
- **Credential:** PNP-PC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | APRN11012885 | FL | Yes |

## Other

- **Enumeration date:** 06/29/2021
- **Last updated:** 09/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 111087300 | — | FL |
| 01 | — | 8ITXD | BLUE CROSS BLUE SHIELD | FL |