Individual
MRS. KELLY MARTIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1330 BOILING SPRINGS RD, SUITE 1600, SPARTANBURG, SC 29303-4201
(864) 582-6396
Mailing address
1330 BOILING SPRINGS RD, SUITE 1600, SPARTANBURG, SC 29303-4201
(864) 582-6396
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1237
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0886PA
—
SC
Enumeration date
10/13/2007
Last updated
11/09/2012
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