Individual
KIMBERLY SHANNON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5401 KINGSTON PIKE, STE 170, KNOXVILLE, TN 37919-5022
(865) 584-4005
(865) 584-5551
Mailing address
813 S NORTHSHORE DR, STE 105, KNOXVILLE, TN 37919-7594
(865) 584-4005
(865) 584-5551
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P0000002498
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3983201
—
TN
Enumeration date
01/22/2007
Last updated
08/17/2015
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