Provider Demographics
NPI:1245247428
Name:WILSON, CAROLYN ANN (CRNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 HIGHWAY 43
Mailing Address - Street 2:STE 24
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2849
Mailing Address - Country:US
Mailing Address - Phone:256-356-9537
Mailing Address - Fax:256-359-2315
Practice Address - Street 1:14001 HIGHWAY 43
Practice Address - Street 2:STE 24
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2849
Practice Address - Country:US
Practice Address - Phone:256-398-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics