1073538864 NPI number — KATHY WILSON, M.D., P. A.

Table of content: (NPI 1073538864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073538864 NPI number — KATHY WILSON, M.D., P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHY WILSON, M.D., P. A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073538864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 291826
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78029-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-792-1132
Provider Business Mailing Address Fax Number:
830-792-7747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 HILL COUNTRY DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
KERRVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78028-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-792-1132
Provider Business Practice Location Address Fax Number:
830-792-7747
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-792-1132

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC8043 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00191112 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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