Most Relevant Information
Provider Data
| NPI Number: | 1003465337 |
| Provider Name: | KAITLIN WILSON CNM, WHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LW0102X |
| Specialty: | Nurse Practitioner |
| License Number: | 251088 |
Most Important Dates
| Enumeration Date: | 09/09/2019 |
| Last Updated: | 09/09/2019 |
Provider Practice Location
5195 JIMMY CARTER BLVD
NORCROSS
GA
300931649
Practice Location Phone/Fax
| Phone: | 4705145818 |
| Fax: |
Provider Mailing Location
4491 VILLAGE SPRINGS PL
DUNWOODY
GA
303382401
Provider Mailing Phone/Fax
| Phone: | 5717210455 |
| Fax: |