Provider Demographics
NPI:1053118877
Name:WILSON, KAITLYN RENEE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4651
Mailing Address - Country:US
Mailing Address - Phone:402-805-0928
Mailing Address - Fax:
Practice Address - Street 1:7410 POPLAR RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-4651
Practice Address - Country:US
Practice Address - Phone:402-805-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion