Provider Demographics
NPI:1407165988
Name:WILSON, KIRK B JR (NCMTB)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:B
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:NCMTB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BONIFACE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3132
Mailing Address - Country:US
Mailing Address - Phone:907-320-0306
Mailing Address - Fax:
Practice Address - Street 1:2900 BONIFACE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3132
Practice Address - Country:US
Practice Address - Phone:907-320-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist