Individual
MRS. KIMBERLY ELLISON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1325 MCFARLAND BLVD, SUITE 104, NORTHPORT, AL 35476-3270
(205) 330-5266
(205) 330-9915
Mailing address
1325 MCFARLAND BLVD, SUITE 104, NORTHPORT, AL 35476-3270
(205) 330-5266
(205) 330-9915
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-078924
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115069/1336474964
—
AL
01
—
511-00428
BCBS OF ALABAMA
AL
Enumeration date
08/15/2007
Last updated
09/25/2012
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