Provider Demographics
NPI:1922246560
Name:WILSON, KARI RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5444
Mailing Address - Country:US
Mailing Address - Phone:817-637-4358
Mailing Address - Fax:
Practice Address - Street 1:115 E LEE AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5444
Practice Address - Country:US
Practice Address - Phone:817-637-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201593501Medicaid
TXP00696384OtherMEDICARE RAILROAD
TX8L8777Medicare PIN