IndividualActive
Alex Wilson
NPI 1104294073 · Other Technician · Kennett, MO
Provider details
- NPI number
- 1104294073
- Entity type
- Individual
- Primary specialty
- Other TechnicianTechnologists, Technicians & Other Technical Service Providers
- Sex
- Male
- Sole proprietor
- No
Practice location
1109 Jones St
Kennett, MO 63857-3824
Phone: (573) 888-6454
Fax: (573) 888-2369
Mailing address
1109 Jones St
Kennett, MO 63857-3824
Registry dates
- Enumerated
- 2015-09-09
- Last updated
- 2015-09-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.