Provider Demographics
NPI:1073538864
Name:KATHY WILSON, M.D., P. A.
Entity Type:Organization
Organization Name:KATHY WILSON, M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:830-792-1132
Mailing Address - Street 1:PO BOX 291826
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1826
Mailing Address - Country:US
Mailing Address - Phone:830-792-1132
Mailing Address - Fax:830-792-7747
Practice Address - Street 1:703 HILL COUNTRY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5904
Practice Address - Country:US
Practice Address - Phone:830-792-1132
Practice Address - Fax:830-792-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC8043OtherMEDICARE RAILROAD GROUP
TXP00191112OtherMEDICARE RAILROAD
TXP00191112OtherMEDICARE RAILROAD
TXDC8043OtherMEDICARE RAILROAD GROUP