Kathleen P. Wilson, PHD,CPNP, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP 1018702 Issued in FL

Practice address

Fsu Health Lifestyle Medicine Clinic
1630 Riggins Road
Tallahassee, FL 32308

Phone

(850) 878-4434

Fax

(949) 655-8526

NPI assigned

Nov 27, 2008

Last updated

Feb 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida State UniversityGroup PAC ID 2163795964, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner, Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Florida State University

  dba FSU Speech & Hearing Clinic

  • Audiologist
  • Tallahassee, FL
  • NPI 1497946461
  Medicare reassignment Care Compare group
• Florida State University

  dba FSU Speech & Hearing Clinic

  • Speech-Language Pathologist
  • Tallahassee, FL
  • NPI 1053309807
  NPD
• Florida State University

  dba FSU Healthy Lifestyle Medicine Clinic

  • Primary Care Nurse Practitioner
  • Tallahassee, FL
  • NPI 1902003536
  NPD
• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  NPD
• Florida State University

  dba FSU University Health Services

  • Student Health Clinic/Center
  • Tallahassee, FL
  • NPI 1699809236
  NPD (past)
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

{
    "created_epoch": "1227744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1679728026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FSU HEALTH LIFESTYLE MEDICINE CLINIC",
            "address_2": "1630 RIGGINS ROAD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-878-4434",
            "fax_number": "949-655-8526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FSU HEALTH LIFESTYLE MEDICINE CLINIC",
            "address_2": "1630 RIGGINS ROAD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-878-4434",
            "fax_number": "949-655-8526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KATHLEEN",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PHD,CPNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-27",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP 1018702",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 1018702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D'Vonshay Wilson, RBT
• David Brent Wilson, PA-C
• Irene Bahmann Wilson, ARNP
• Jo Ann Wilson, RN
• Jodi Wilson, MD
• Lajasmaine Wilson
• Lauren Lea Wilson, MD
• Lauryn Marie Wilson
• Leslie Dean Wilson, M.D.
• Luvy Wilson

• Family Nurse Practitioner in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.