Individual
KRISTAL LEE ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10302 BROOKRIDGE VILLAGE BLVD STE 103-104, LOUISVILLE, KY 40291-4475
(502) 276-5300
(502) 576-5376
Mailing address
10302 BROOKRIDGE VILLAGE BLVD STE 103-104, LOUISVILLE, KY 40291-4475
(502) 576-5300
(502) 576-5376
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
01084557A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
48792
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201298810
—
IN
05
—
7100212070
—
KY
Enumeration date
04/11/2011
Last updated
10/11/2023
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