Individual
KATHLEEN S WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6000 HARRY HINES BLVD, HAMON BLDG, ROOM NA2 508A, DALLAS, TX 75390-0001
(214) 648-1620
(214) 648-4080
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 648-1620
(214) 648-4080
Taxonomy
Speciality
Code
Description
License number
State
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
Primary
J2416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110712003
—
TX
Enumeration date
10/06/2006
Last updated
01/07/2009
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