Provider Demographics
NPI:1982417481
Name:WILSON, KRISSY
Entity type:Individual
Prefix:
First Name:KRISSY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 W STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-8301
Mailing Address - Country:US
Mailing Address - Phone:937-508-6996
Mailing Address - Fax:
Practice Address - Street 1:1680 W STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-8301
Practice Address - Country:US
Practice Address - Phone:937-508-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide