Provider Demographics
NPI:1306293337
Name:WILCOX, KRISTIN LOUISE (CNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LOUISE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LOUISE
Other - Last Name:WOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:460 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-3196
Mailing Address - Fax:614-293-4812
Practice Address - Street 1:1717 13TH ST STE 210
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-297-5660
Practice Address - Fax:425-297-5505
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH382858163WX0002X
OH019456363LW0102X
WAAP61013991363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk