Individual
KINDEE LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSAT, LAT, ATC
Contact information
Practice address
3804 N 1900 E, FILER, ID 83328-5242
(208) 731-5480
Mailing address
3804 N 1900 E, FILER, ID 83328
(208) 731-5480
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-595
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000025663
BOC
ID
Enumeration date
10/24/2016
Last updated
10/24/2016
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