Provider Demographics
NPI:1518980762
Name:WILSON, CHRISTY L (APRN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7934
Mailing Address - Country:US
Mailing Address - Phone:270-441-4357
Mailing Address - Fax:270-441-4132
Practice Address - Street 1:225 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7934
Practice Address - Country:US
Practice Address - Phone:270-441-4357
Practice Address - Fax:270-441-4132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002126363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner