Kellie R Wilson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703108511 Issued in MI

Practice address

385 7TH St
Manistee, MI 49660-1966

Phone

(231) 233-2565

Fax

(231) 723-6335

NPI assigned

Mar 31, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1013370634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 7TH ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496601966",
            "telephone_number": "231-233-2565",
            "fax_number": "231-723-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 7TH ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496601966",
            "telephone_number": "231-233-2565",
            "fax_number": "231-723-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLIE",
        "middle_name": "R",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703108511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Western Michigan Apothecaries, Inc
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• Carl Walter Wilberg, D.O.
• Russell G Williams, D.O.
• Nicole M Wisniewski, PA-C
• Cheryl M Wolfram, CHW
• Gregory A Wright, LLP
• Sarah Wright
• Todd Yaple, LMSW

• Licensed Practical Nurse in Manistee, MI
• Providers in Manistee, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.