Provider Demographics
NPI:1861788366
Name:WILSON, KIMBERLY B (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BIRCHBARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759
Mailing Address - Country:US
Mailing Address - Phone:828-230-3194
Mailing Address - Fax:
Practice Address - Street 1:43 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4807
Practice Address - Country:US
Practice Address - Phone:828-252-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine