Provider Demographics
NPI:1851123343
Name:WILSON, KAUL (CNP)
Entity type:Individual
Prefix:
First Name:KAUL
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:BUSHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79012-0016
Mailing Address - Country:US
Mailing Address - Phone:806-310-9855
Mailing Address - Fax:806-310-9857
Practice Address - Street 1:1600 S FM 2381
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1900
Practice Address - Country:US
Practice Address - Phone:806-310-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily