Individual
CHARLIE K. WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 RAVEN HILL DRIVE, ATCHISON, KS 66002
(913) 367-2131
(913) 674-2023
Mailing address
800 RAVEN HILL DRIVE, ATCHISON, KS 66002
(913) 367-2131
(913) 674-2023
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
557391
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014014788
LICENSE
MO
Enumeration date
07/23/2014
Last updated
12/15/2016
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