Individual
KELLY MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
111 MURPHREE AVE, CENTERVILLE, TN 37033-1418
(931) 729-3516
Mailing address
111 MURPHREE AVE, CENTERVILLE, TN 37033-1418
(931) 729-3516
(931) 729-5029
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
49930
TN
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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