Provider Demographics
NPI:1235411505
Name:WILCOX, KATIE CHRISTINE (RN FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CHRISTINE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 COUNCIL ST NE
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2471
Mailing Address - Country:US
Mailing Address - Phone:319-221-8444
Mailing Address - Fax:
Practice Address - Street 1:5264 COUNCIL ST NE
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2471
Practice Address - Country:US
Practice Address - Phone:319-221-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 201313-4363LF0000X
IA118250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN500007025Medicare PIN