Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2014018817 | MO |
NPI | 1003222712 |
---|---|
Provider Name | Kailey Wilson |
First Address | Lees Summit, MO 64064-3226 |
Second Address | Lees Summit, MO 64064-3226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 08/05/2019 |