Provider Demographics
NPI:1396862223
Name:WILSON, KRISTI JO (FNP - BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:JO
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:JO
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:8293 OFFICE PARK DR.
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-694-3576
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:8293 OFFICE PARK DR.
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-694-3576
Practice Address - Fax:810-235-2721
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704162286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4762420Medicaid
MI0B51149OtherBLUE SHIELD
MI0B51149OtherBLUE SHIELD