Provider Demographics
NPI:1437484706
Name:WILSON, KRISTIE L (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15930 S GREAT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5800
Mailing Address - Country:US
Mailing Address - Phone:512-255-8868
Mailing Address - Fax:512-255-8869
Practice Address - Street 1:15930 S GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5800
Practice Address - Country:US
Practice Address - Phone:512-255-8868
Practice Address - Fax:512-255-8869
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689938363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics