| Doctor Name: | KENDRA WILSON |
| NPI Number: | 1255755997 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | RN144375 |
| Business Practice Address: | 483 W. Seed Farm Rd. Hu Hu Kam Memorial Hospital Sacaton, AZ - 85147 |
| Business Phone Number: | 6025281200 |
| Business Fax Number: | 6025281255 |
| Mailing Address: | P.o. Box 38, Hu Hu Kam Memorial Hospital SACATON |
| State: | AZ |
| Postal Code: | 85147 |
| Phone Number: | 6025281200 |
| Fax Number: | 6025281255 |
| NPI Enumeration Date: | 02/18/2014 |
| NPI Last Update Date: | 04/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | RN144375 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |