Provider Demographics
NPI:1013269877
Name:WILSON, KASIE
Entity Type:Individual
Prefix:MS
First Name:KASIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1425
Mailing Address - Country:US
Mailing Address - Phone:940-642-8317
Mailing Address - Fax:855-822-0323
Practice Address - Street 1:3509 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1425
Practice Address - Country:US
Practice Address - Phone:940-642-8317
Practice Address - Fax:855-822-0323
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12090011176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife