Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 53-77013 | KS |
NPI | 1033309265 |
---|---|
Provider Name | Roy P Wilson |
First Address | Topeka, KS 66604-2603 |
Second Address | Topeka, KS 66604-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 28/08/2020 |