Individual
ANNIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1401 HARRODSBURG RD STE C100, LEXINGTON, KY 40504-1780
(859) 278-4960
(859) 277-2840
Mailing address
PO BOX 936, LONDON, KY 40743-0936
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2341
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100517210
—
KY
Enumeration date
06/11/2015
Last updated
07/03/2019
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