Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | RN175565 | GA |
NPI | 1114359494 |
---|---|
Provider Name | Kelli Corine Wilson |
First Address | Nashville, TN 37215-2691 |
Second Address | Nashville, TN 37232-5648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 06/01/2022 |