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Individual

WALTER WILSON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
54415
KY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
54415
KY LICENSE
KY
Enumeration date
04/21/2015
Last updated
04/01/2021
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