Provider Demographics
NPI:1407334022
Name:WILSON, CATHERINE CORNELIA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:CORNELIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
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Mailing Address - Street 1:1030 E US HIGHWAY 377 STE 110 PMB 117
Mailing Address - Street 2:070142
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048
Mailing Address - Country:US
Mailing Address - Phone:817-910-8049
Mailing Address - Fax:877-461-4979
Practice Address - Street 1:1321 WATERS EDGE DR STE 1004
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1233
Practice Address - Country:US
Practice Address - Phone:817-910-8049
Practice Address - Fax:877-461-4979
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP138615363LF0000X, 363LF0000X
COAPN0995446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily