KRISTAL LEE ANN WILSON (NPI# 1578853602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578853602 |
| Entity Type | Individual |
| Full Name | KRISTAL LEE ANN WILSON |
| Credential | MD |
| Practice Address |
6400 Dutchmans Pkwy Ste 60 Louisville KY 40205-3341 |
| Mailing Address |
1101 Professional Blvd Ste 100 Evansville IN 47714-8018 |
| Practice Telephone | 8124777246 |
| Practice Fax Number | 8124777240 |
| Mailing Telephone | 8124777246 |
| Mailing Fax Number | 8124777240 |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2020-09-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LA0401X |
Anesthesiology Specialization: Addiction Medicine |
48792 | KY | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 48792 | KY | Allopathic & Osteopathic Physicians |
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
48792 | KY | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
48792 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100212070 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5722 Outer Loop, Louisville, KY 402194156 | 5024927455 | 5029210222 |
| 2201 Green Valley Rd, New Albany, IN 471504647 | 8129491223 | 8129454765 |
| 2400 Eastpoint Pkwy Ste 410, Louisville, KY 402234154 | 5022536625 | 5022536629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134533862 | Kristal Wilson | Community Based Residential Treatment Facility, Mental Illness | 2470 Wrondel Way Ste 275, Reno, NV 89502-3701 | 2014-06-20 |
| Street Address |
6400 DUTCHMANS PKWY STE 60 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40205-3341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265525653 | Bill Walker Haney | Pain Medicine | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2006-09-30 |
| 1316579667 | Jones Anesthesia LLC | Nurse Anesthetist, Certified Registered | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2020-02-05 |
| 1235773789 | Pain Management Centers of America, Psc | Psychiatry & Neurology | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2019-10-28 |
| 1699140954 | Lillie Becht | Physician Assistant | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2015-12-11 |
| 1134558927 | Deborah Hart | Physician Assistant | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2013-11-02 |
| 1003195983 | Bluegrass Pain Consultants Pllc | Pain Medicine | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2011-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558844027 | Arthur James Shulthise Jr. | Family Medicine | Bldg. 2801 - Bowman Field, 2801 Taylorsville Road, Louisville, KY 40205 | 2018-09-11 |
| 1609392133 | Leah Elizabeth Storch | Occupational Therapist | 2231 Wendell Ave, Louisville, KY 40205 | 2017-08-16 |
| 1437679842 | Michael Edward Lovelace | Family Medicine | 1800 Stevens Avenue, Louisville, KY 40205 | 2017-06-27 |
| 1699205328 | Nathaniel George Kennedy | Physician Assistant | 3101 Bardstown Road, Sullivan University Physician Assistant Program, Louisville, KY 40205 | 2017-06-14 |
| 1225584972 | Kalpana Bhaskar | Pharmacist | 3036 Bardstown Road, Louisville, KY 40205 | 2016-08-31 |
| 1013398627 | William Wood | Hearing Instrument Specialist | 2239 Bardstown Rd., Louisville, KY 40205 | 2015-06-10 |
| 1811306707 | Alaina Rotelli | Pharmacist | 2100 Gardiner Lane, Louisville, KY 40205 | 2014-08-05 |
| 1013325760 | Jaime Alexandra Seelmeyer | Counselor | 1718 Deerwood Ave, Apt 1, Louisville, KY 40205 | 2014-07-25 |
| 1992009336 | Priscilla Freeman | Case Manager/Care Coordinator | 3171 Taylorsville Rd, 1st Floor, Louisville, KY 40205 | 2010-12-28 |
| 1457501413 | Amanda Christine Voils-levenda | Psychologist | 1911 Bardstown Rd, Suite #bl, Louisville, KY 40205 | 2008-09-26 |
| Find all providers in zip 40205 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578981718 | Restore Rehabilitation | Pain Medicine | 6400 Dutchmans Pkwy Ste 80, Louisville, KY 40205-3340 | 2014-04-04 |
| 1235358243 | Gary L Reasor, Md P.s.c | Pain Medicine | 4121 Dutchmans Ln Ste 606, Louisville, KY 40207-4725 | 2007-04-25 |
| 1407995517 | Cassari Pain Treatment Center Inc | Pain Medicine | 4010 Dupont Circle #430, Louisville, KY 40207 | 2007-02-05 |
| 1265525653 | Bill Walker Haney | Pain Medicine | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2006-09-30 |
| 1467441915 | Larry L Zhou | Pain Medicine | 1230 S Hurstbourne Pkwy, Unit 120, Louisville, KY 40222-5757 | 2005-10-18 |
| 1073134664 | Commonwealth Pain Associates Pllc | Pain Medicine | 225 Executive Park, Louisville, KY 40207-4202 | 2020-05-05 |
| 1396120820 | Gml Pain Md Psc | Pain Medicine | 11300 Maple Brook Dr, Louisville, KY 40241-2080 | 2015-07-27 |
| 1003195983 | Bluegrass Pain Consultants Pllc | Pain Medicine | 6400 Dutchmans Pkwy Ste 60, Louisville, KY 40205-3341 | 2011-08-10 |
| 1790096980 | Brandon Michael Sutton | Pain Medicine | 1169 Eastern Pkwy, Louisville, KY 40217-1417 | 2010-06-23 |
| 1124356811 | Brigid M Buckman | Pain Medicine | 2400 Eastpoint Pkwy, Suite 410, Louisville, KY 40223-4154 | 2009-11-18 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40205 |
Please comment or provide details below to improve the information on KRISTAL LEE ANN WILSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.