Provider Demographics
NPI:1770596678
Name:WILSON, KATHERINE (DO)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 N SILVERBELL RD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7373
Mailing Address - Country:US
Mailing Address - Phone:520-202-7770
Mailing Address - Fax:520-202-7773
Practice Address - Street 1:8333 N SILVERBELL RD
Practice Address - Street 2:SUITE 161
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7373
Practice Address - Country:US
Practice Address - Phone:520-202-7770
Practice Address - Fax:520-202-7773
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9400207Q00000X
AZ4689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ243878Medicaid
AZ117250Medicare PIN