Basic Information
| Provider Information | |||||||||
| NPI: | 1578543740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | WILSON | ||||||||
| OtherFirstName: | KAREN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 51 MCMICHAEL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283746702 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10880 DURANT RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276146629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192356433 | ||||||||
| FaxNumber: | 9193501404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2006 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 208D00000X | WA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 24057 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 390200000X | NE | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207VM0101X | 2013-02311 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.