Provider Demographics
NPI:1295337541
Name:WILSON, CRYSTAL ANN (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-6515
Mailing Address - Country:US
Mailing Address - Phone:270-389-5000
Mailing Address - Fax:
Practice Address - Street 1:4604 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6515
Practice Address - Country:US
Practice Address - Phone:270-389-5054
Practice Address - Fax:270-389-5094
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28228168A363LF0000X
KY3015121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily