Individual
KELLIE MARIE RYAN - WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
220 E. HARRIS, SAN ANGELO, TX 76903
(325) 658-1511
(325) 481-2165
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2165
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
AP111628
TX
367A00000X
Advanced Practice Midwife
Primary
AP111628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170388603
—
TX
01
—
8Y3124
BCBS
TX
Enumeration date
04/06/2006
Last updated
12/18/2020
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