Individual
KIMBERLY D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
1925 WARRIOR WAY, ADA, OK 74820-3491
(580) 436-3980
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
64465
OK
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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