Wilson, Jack Kenney

Wilson, Jack Kenney is an individual health care provider with primary practice located at 637 S Kerr Ave , Wilmington NC 28403-8423. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wilson, Jack Kenney can be contacted via phone (910) 799-1810.

Contact Information

Primary practice address
637 S Kerr Ave Wilmington NC 28403-8423
Phone: (910) 799-1810
Fax: (910) 452-2571
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 16755 North Carolina

Profile Details

NPI number 1356349559
LBN Legal business name Wilson, Jack Kenney
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Sep 20th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356349559 NPPES
North Carolina Other 02701 BCBS NC
North Carolina MEDICAID 8902701 BCBS NC

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