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Individual

KATHY A. WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
2010 LEWIS TURNER BLVD, FORT WALTON BEACH, FL 32547-1352
(850) 863-3000
(850) 862-1621
Mailing address
151 MARY ESTHER BLVD, STE 408, MARY ESTHER, FL 32569-1975
(850) 863-3000
(850) 862-1621

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9162558
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
303882300
FL
Enumeration date
12/14/2005
Last updated
09/12/2017
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