Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 15525 | TX |
N | 101YM0800X | Mental Health Counselor | 84153 | TX |
N | 174N00000X | Lactation Consultant | ||
Y | 175F00000X | Naturopath | 07-1039 | AZ |
N | 175L00000X | Homeopath | 071039 | AZ |
N | 176B00000X | Midwife | ||
N | 225700000X | Massage Therapist | MI3923 | TX |
NPI | 1235316159 |
---|---|
Provider Name | Dr. Kimberly M Wilson |
First Address | Phoenix, AZ 85016-7844 |
Second Address | Phoenix, AZ 85016-7844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 01/01/2022 |