Provider Demographics
NPI:1578543740
Name:WILSON, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:51 MCMICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WOMACK OB GYN CLINIC BLDG 4
Practice Address - Street 2:2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-4810
Practice Address - Country:US
Practice Address - Phone:910-907-8471
Practice Address - Fax:910-908-7379
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276030207V00000X, 207VM0101X
WA208D00000X207V00000X
NE24057207VM0101X
NC2013-02311207VM0101X
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program