Individual
MISS KATHERINE EMILY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3020 NEW BERN AVE, RALEIGH, NC 27610
(919) 350-8284
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05516
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669863270
—
NC
Enumeration date
02/18/2015
Last updated
04/15/2021
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