Individual
KYLAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CERTIFIED PEDORTHIST
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
4075
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPED4075
CERTIFICATION
TX
Enumeration date
05/13/2014
Last updated
05/13/2014
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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