Provider Demographics
NPI:1528463791
Name:WILSON, KAREN JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:201 NORMAN DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9335
Mailing Address - Country:US
Mailing Address - Phone:757-566-3569
Mailing Address - Fax:757-566-3569
Practice Address - Street 1:3050 REGENT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3196
Practice Address - Country:US
Practice Address - Phone:214-689-8079
Practice Address - Fax:877-457-3988
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
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Provider Licenses
StateLicense IDTaxonomies
VA0024050712363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology