Provider Demographics
NPI:1609177559
Name:WILSON, KRISTEN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2126
Mailing Address - Country:US
Mailing Address - Phone:859-282-0119
Mailing Address - Fax:859-282-8018
Practice Address - Street 1:7315 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2126
Practice Address - Country:US
Practice Address - Phone:859-282-0119
Practice Address - Fax:859-282-8018
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1723103T00000X, 103TC0700X, 103TC2200X, 103TB0200X, 103TF0000X, 103TP2701X
OH6925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy