Provider Demographics
NPI:1164715579
Name:WILSON, KRISTIN LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1155 MILL ST # MS 14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:15 MCCABE DR STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4815
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3970
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA112091208000000X
NV17988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164715579Medicaid