Individual
ADA KENETRA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7666 CHARLOTTE HWY, STE 120, INDIAN LAND, SC 29707-7000
(803) 431-8220
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
21747
SC
363LF0000X
Family Nurse Practitioner
Primary
21747
SC
Other
Enumeration date
03/20/2015
Last updated
07/15/2024
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