Individual
MISS CRYSTIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 CENTRAL METHODIST SQ, FAYETTE, MO 65248-1104
(816) 500-6273
Mailing address
403 S SUNRISE DR, RAYMORE, MO 64083-9292
(816) 500-6273
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/04/2016
Last updated
12/04/2016
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