Individual
KIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
375 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1260
(801) 674-1405
Mailing address
5955 WASATCH DR, OGDEN, UT 84403-5298
(801) 674-1405
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
9888137-4810
UT
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/16/2017
Last updated
12/27/2021
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