Provider Demographics
NPI:1194031765
Name:WILSON, LINDSEY D (CNM)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 W 110TH ST
Mailing Address - Street 2:STE 36
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1401
Mailing Address - Country:US
Mailing Address - Phone:913-735-4888
Mailing Address - Fax:888-927-5843
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:STE 110
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4434
Practice Address - Country:US
Practice Address - Phone:757-223-9794
Practice Address - Fax:757-223-9168
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036527367A00000X
TX714085367A00000X
KS53-78122367A00000X
VA0024173216367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife