Individual
KATELYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 UNIVERSITY BLVD, UH 1501, INDIANAPOLIS, IN 46202-5149
(317) 948-1310
(317) 948-0503
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001438A
IN
Other
Enumeration date
09/17/2012
Last updated
02/26/2014
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