Individual
KIMBERLY SUSANN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6000
(864) 560-7715
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3974
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1547
—
SC
Enumeration date
01/26/2009
Last updated
01/18/2021
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