Provider Information for 1548812274
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KRISTEN NICOLE WILSON LCSW
Sex: Female
NPI: 1548812274
Last Updated: 2019-07-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1548812274 | ||||||||||||
| Enumeration Date | 2019-07-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4900 SW 46TH CT APT 211 OCALA, FL 34474-6264 United States Phone: 309-825-8704 | Fax: | ||||||||||||
| Primary Practice Address | 4900 SW 46TH CT APT 211 OCALA, FL 34474-6264 United States Phone: 309-825-8704 | Fax: | ||||||||||||
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