Provider Demographics
NPI:1073883336
Name:KATHY WILSON ARNP FAMILY NURSE PRACTITIONER AND ASSOCIATES
Entity Type:Organization
Organization Name:KATHY WILSON ARNP FAMILY NURSE PRACTITIONER AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-226-8588
Mailing Address - Street 1:322 RACETRACK RD NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2546
Mailing Address - Country:US
Mailing Address - Phone:850-226-8588
Mailing Address - Fax:
Practice Address - Street 1:322 RACETRACK RD NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2546
Practice Address - Country:US
Practice Address - Phone:850-226-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9162558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty