Individual
MRS. KELLY NICOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1826 VETERANS BLVD, DUBLIN, GA 31021-3620
(478) 272-1210
Mailing address
1126 MOUNT OLIVE RD, IRWINTON, GA 31042-2118
(478) 272-1210
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN159391
GA
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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