Individual
KELLY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5030 J ST, STE 201, SACRAMENTO, CA 95819-3800
(916) 455-1155
Mailing address
5030 J ST, STE 201, SACRAMENTO, CA 95819-3800
(916) 455-1155
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21542
CA
Other
Enumeration date
04/12/2011
Last updated
01/18/2017
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