Individual
KEVIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5412 BOULDER HWY, LAS VEGAS, NV 89122-6039
(702) 291-7121
Mailing address
5412 BOULDER HWY, LAS VEGAS, NV 89122-6039
(702) 291-7121
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871915892
WELL CARE SERVIES
NV
Enumeration date
07/24/2017
Last updated
07/21/2022
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