Individual
KAREN EVONNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D., PA-C
Contact information
Practice address
8890 N UNION BLVD STE 220, COLORADO SPRINGS, CO 80920-2701
(719) 574-9191
Mailing address
2 S CASCADE AVE STE 140, COLORADO SPRINGS, CO 80903-1604
(719) 538-2900
(719) 538-2990
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
363A00000X
Physician Assistant
Primary
PA.0004345
CO
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53878841
—
CO
Enumeration date
01/30/2007
Last updated
02/16/2024
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