Provider Demographics
NPI:1689142259
Name:WILSON, KENDRA NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10840 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3558
Mailing Address - Country:US
Mailing Address - Phone:352-445-1200
Mailing Address - Fax:
Practice Address - Street 1:10840 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484
Practice Address - Country:US
Practice Address - Phone:352-445-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant