Kimberly Lannette Wilson, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1303 Issued in NC

Practice address

2015 Ayrsley Town Blvd
Suite 202
Charlotte, NC 28273-4067

Phone

(704) 280-8502

Fax

(800) 858-2194

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberlywilson@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Marriage & Family Therapist

  NPD

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1265587430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15105D JOHN J DELANEY DR STE 192",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772741",
            "telephone_number": "704-769-0660",
            "fax_number": "800-858-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 AYRSLEY TOWN BLVD",
            "address_2": "SUITE 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282734067",
            "telephone_number": "704-280-8502",
            "fax_number": "800-858-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "LANNETTE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TN",
            "license": "785",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "4101006188",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT000954",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "1303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090073276A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keisha Chalet Wilson, HAIR LOSS SPECIALIST
• Kelly Brooks Wilson, DDS
• Kelly Comolli Wilson, MD
• Kelsi Wilson, LMFT
• Kennedy Grace Wilson
• Lamar Wilson
• Lee Avery Wilson, LCSW
• Lindsey Elise Wilson, MD
• Lisa Kay Wilson, MD
• Lori Ann Wilson, RESPIRATORY THERAPY

• Marriage & Family Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; 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.