Individual
RONALD RAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 HOSPITAL DR, MADISONVILLE, KY 42431-1644
(270) 825-5100
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5043A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000513977
BCBS PROVIDER NUMBER
—
05
—
74012543
—
KY
01
—
CRNA LICENSE
5043A
KY
Enumeration date
12/04/2006
Last updated
01/23/2015
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