Provider Demographics
NPI:1114095841
Name:WILSON, KATHY TINGLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:TINGLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 890273
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0273
Mailing Address - Country:US
Mailing Address - Phone:828-326-2600
Mailing Address - Fax:828-326-2671
Practice Address - Street 1:3521 GRAYSTONE PL SE
Practice Address - Street 2:SUITE 202
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8268
Practice Address - Country:US
Practice Address - Phone:828-326-2660
Practice Address - Fax:828-326-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC01566207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2075619AMedicare Oscar/Certification
NC2075619Medicare PIN
NC5909327Medicaid