Kerri Wilson, NP
Individual provider Active NPI Nurse Practitioner · Fairway, KS
NPI 1558022533 · NPPES record last updated Jan 3, 2022
Key facts
- NPI
- 1558022533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 53-80804-072 (KS)
- Practice address
- 6114 Delmar St
Fairway, KS 66205-3232 - Phone
- (913) 742-0828
- NPI assigned
- Jan 3, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53-80804-072 | KS | MD | Nurse Practitioner |
| 2021050330 | MO | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2021050330 | MO | |
| Nurse Practitioner | 363L00000X | 53-80804-072 | KS | Yes |
Addresses
Primary practice location
6114 Delmar St
Fairway, KS 66205-3232
Mailing address
6114 Delmar St
Fairway, KS 66205-3232
Phone (913) 742-0828
Other providers in Fairway, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.