Provider Demographics
NPI:1578142204
Name:WILSON, KASEY HAWKINS (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:HAWKINS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 MOUNT CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:AL
Mailing Address - Zip Code:35952-9111
Mailing Address - Country:US
Mailing Address - Phone:256-298-6768
Mailing Address - Fax:
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-780-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner