Provider Demographics
NPI:1841177623
Name:WILSON, KEVIN A (CRPA-P)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:CRPA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WHITESBORO ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3015
Mailing Address - Country:US
Mailing Address - Phone:315-724-5168
Mailing Address - Fax:315-724-6582
Practice Address - Street 1:500 WHITESBORO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3015
Practice Address - Country:US
Practice Address - Phone:315-607-2115
Practice Address - Fax:315-607-2115
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-P-8736175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist