Individual
ANNE KELLY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3399 E LOUISE DR STE 100, MERIDIAN, ID 83642-5212
(208) 887-6813
(208) 887-6884
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1592
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2019
Last updated
08/04/2025
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