Provider Demographics
NPI:1295821718
Name:WILSON, ANN-KATRIN (MD)
Entity Type:Individual
Prefix:
First Name:ANN-KATRIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2367
Mailing Address - Country:US
Mailing Address - Phone:205-836-8691
Mailing Address - Fax:205-212-7102
Practice Address - Street 1:520 SIMMONS DR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2367
Practice Address - Country:US
Practice Address - Phone:205-836-8691
Practice Address - Fax:205-212-7102
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000097553Medicaid
AL169411Medicaid
AL000097553Medicaid