Individual
MS. TINA L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP RN
Contact information
Practice address
580 WESTPORT RD, ELIZABETHTOWN, KY 42701-2949
(270) 765-6196
(270) 763-0397
Mailing address
PO BOX 2609, ELIZABETHTOWN, KY 42702-2609
(270) 769-1601
(270) 765-7274
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1072465
KY
363LW0102X
Women's Health Nurse Practitioner
Primary
2609P
KY
Other
Enumeration date
03/09/2006
Last updated
02/06/2012
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