Individual
KAREN RENE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, PT
Contact information
Practice address
9100 CENTENNIAL CIR, ANCHORAGE, AK 99504-1480
(406) 531-5276
Mailing address
4011 FIELDSTONE XING, MISSOULA, MT 59802-8602
(406) 531-5276
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2777
AK
225100000X
Physical Therapist
492
MT
363AM0700X
Medical Physician Assistant
298
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679645683
—
AK
05
—
4302623
—
MT
Enumeration date
11/14/2006
Last updated
06/10/2014
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