Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 12090011 | TX |
NPI | 1013269877 |
---|---|
Provider Name | Ms. Kasie Wilson |
First Address | Wichita Falls, TX 76308-1425 |
Second Address | Wichita Falls, TX 76308-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 03/10/2012 |