Individual
KATHY LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
402 S SILVER SPRINGS RD, CAPE GIRARDEAU, MO 63703-7536
(573) 334-1100
(573) 651-4345
Mailing address
402 S SILVER SPRINGS RD, CAPE GIRARDEAU, MO 63703-7536
(573) 334-1100
(573) 651-4345
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023047220
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420136965
—
MO
Enumeration date
12/11/2023
Last updated
09/17/2024
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