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Kelly Diane Wilson, MS,ATC
Student in an Organized Health Care Education/Training Program in Costa Mesa, California
NPI 1801349162

Kelly Diane Wilson is a Student in an Organized Health Care Education/Training Program based in Costa Mesa, CA. Kelly Diane Wilson practices in Costa Mesa, CA and has the professional credentials of MS,ATC. The NPI Number for Kelly Diane Wilson is 1801349162 and holds a License No. (California).

The current practice location address for Kelly Diane Wilson is 55 Fair Dr, Costa Mesa, CA and can be reached out via phone at 714-619-6618.

Location: 55 Fair Dr, Costa Mesa, CA, 92627-2781
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801349162
Provider Name
Kelly Diane Wilson
Credential
MS,ATC
Provider Entity Type
Individual
Gender
Female
Address
55 Fair Dr, Costa Mesa, CA, 92627-2781
Phone Number
714-619-6618
Fax Number
Provider Enumeration Date
08/03/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
55 Fair Dr
City
Costa Mesa
State
California
Zip
92626-6520
Phone Number
714-619-6618
Fax Number
person
Provider Business Mailing Address Details
Address
55 Fair Dr
City
Costa Mesa
State
California
Zip
92626-6520
Phone Number
714-619-6618
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
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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