Individual
KAYLA DILL WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6030 W HIGHWAY 74, STE D, INDIAN TRAIL, NC 28079-3468
(704) 246-2800
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5015142
NC
363LG0600X
Gerontology Nurse Practitioner
5015142
NC
363LP2300X
Primary Care Nurse Practitioner
5015142
NC
Other
Enumeration date
05/19/2020
Last updated
07/15/2024
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