Individual
KRISTEN MABUS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
380 SERPENTINE DR, SUITE 200, SPARTANBURG, SC 29303-3066
(864) 560-7050
(864) 560-0800
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20205
SC
363LF0000X
Family Nurse Practitioner
207724
NC
363LF0000X
Family Nurse Practitioner
COA 15085 NP
OH
363LF0000X
Family Nurse Practitioner
TL20205
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005571
—
NC
05
—
NP1954
—
SC
Enumeration date
11/20/2011
Last updated
01/19/2021
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