Wilson, Kristal Lee Ann

Wilson, Kristal Lee Ann is an individual health care provider with primary practice located at 10302 Brookridge Village Blvd Ste 103-104 , Louisville KY 40291-4475. She recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Pain Medicine, which is considered as her primary health care specialty. Wilson, Kristal Lee Ann can be contacted via phone (502) 276-5300.

Contact Information

Primary practice address
10302 Brookridge Village Blvd Ste 103-104 Louisville KY 40291-4475
Phone: (502) 276-5300
Fax: (502) 576-5376
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 01084557A Indiana
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 48792 Kentucky

Profile Details

NPI number 1578853602
LBN Legal business name Wilson, Kristal Lee Ann
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2011
Last updated Oct 11th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578853602 NPPES
Kentucky MEDICAID 7100212070
Kentucky MEDICAID 201298810

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