Individual provider · Type 1 NPI

Kelly Diane Wilson, MS, ATC

Student in an Organized Health Care Education/Training Program · Costa Mesa, CA

NPI number 1801349162 Active

Practice location

55 Fair Dr
Costa Mesa, CA 92626-6520

Call (714) 619-6618 Map

Mailing address

602 Center St, Apt C-1
Costa Mesa, CA 92627-2781

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1801349162

Kelly Diane Wilson, MS, ATC's National Provider Identifier is 1801349162, issued on Aug 3, 2016. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Costa Mesa, CA. The record was last updated on Aug 3, 2016.