| Doctor Name: | DR. KIMBERLEE VAN WILSON |
| NPI Number: | 1306134929 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 5840 |
| Business Practice Address: | 1111 W 17th St Tulsa, OK - 741071886 |
| Business Phone Number: | 9185618432 |
| Business Fax Number: | 9185618428 |
| Mailing Address: | 1111 W 17th St, TULSA |
| State: | OK |
| Postal Code: | 741071886 |
| Phone Number: | 9185618432 |
| Fax Number: | 9185618428 |
| NPI Enumeration Date: | 07/17/2011 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | 5840 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |