Individual
KRISTA LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P.
Contact information
Practice address
415 MAIN ST, MALVERN, IA 51551-8152
(712) 624-9185
(712) 624-8827
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A088603
IA
363LF0000X
Family Nurse Practitioner
110991
NE
363LP2300X
Primary Care Nurse Practitioner
A088603
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225001464
—
IA
05
—
470687317-16
—
NE
05
—
47068731712
—
NE
05
—
47068731777
—
NE
Enumeration date
02/08/2006
Last updated
07/15/2016
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