Provider Demographics
NPI:1740991876
Name:WILSON, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUNIPER
Other - Middle Name:LILAC
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FSD
Mailing Address - Street 1:4531 SWISS STONE CT APT 2B
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4960
Mailing Address - Country:US
Mailing Address - Phone:734-263-3012
Mailing Address - Fax:
Practice Address - Street 1:4531 SWISS STONE CT APT 2B
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4960
Practice Address - Country:US
Practice Address - Phone:734-263-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula