Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1710290184 Individual Practitioner Female Practitioner

Kelly Lynn Wilson

Speech-Language Pathologist • Fort Moore, GA

Professional Overview & Biography Verified Profile Summary

Kelly Wilson is a registered healthcare professional specializing in Speech-Language Pathologist in Fort Moore, GA. Practice services are available at 6600 VAN AALST BLVD BLDG 9250 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

6600 Van Aalst Blvd Bldg 9250

Fort Moore, GA 319052102

Telephone 7065457308

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Fort Moore, GA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.3 Yrs
Regional Practice Density
3 Specialists

Practicing in Fort Moore, GA (4796 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-12-13
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License FL SA13784

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
214307501 (TX)
Commercial Insurance / Payer ID Blue Cross Blue Shield
80S945 (TX)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Justin Richel

Student in an Organized Health Care Education/Training Program

NPI 1013852490
Patricia Marrero

Nurse Practitioner - Family

NPI 1023623295
NPI 1053865261

Physical Therapist, Doctor of Physical Therapy, NCS, Orthopedic Clinical Specialist

Virginia Ladner , MS, RD, LD

Dietitian, Registered

NPI 1063171866

Master of Science, Registered Dietitian, Licensed Dietitian

Ruizhi Wu

Student in an Organized Health Care Education/Training Program

NPI 1093521403
Tamika Helton , ACNP

Nurse Practitioner - Family

NPI 1093959165

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location December 13, 2023

Registered at 6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 319052102 (Tel: 7065457308)

📍
Updated Business Mailing Address December 13, 2023

Registered at 6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 319052102 (Tel: 7065457308)

NPI Profile Active January 24, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location January 24, 2017

Registered at 52D MEDICAL GROUP, UNIT 3690, APO, AE 091263690 (Tel: 496565613184)

📍
Updated Business Mailing Address January 24, 2017

Registered at 52D MEDICAL GROUP, UNIT 3690, APO, AE 091263690 (Tel: 496565613184)

👤
Provider Name / Credentials Updated January 24, 2017

Recorded as KELLY WILSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 24, 2017

Speech-Language Pathologist (License #SA13784 in FL)

NPI Profile Active October 01, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location October 01, 2014

Registered at 250 SANTA FE DR, WEATHERFORD, TX 760866585 (Tel: 8175505058)

📍
Updated Business Mailing Address October 01, 2014

Registered at 5914 DRY CREEK LN, ARLINGTON, TX 760173938 (Tel: 2147897891)

👤
Provider Name / Credentials Updated October 01, 2014

Recorded as KELLY WILSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 01, 2014

Speech-Language Pathologist (License #105709 in TX)

🟢
Initial NPI Registration & Enumeration July 14, 2010

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1710290184
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 14, 2010
Last Update: December 13, 2023
Sole Proprietor: Yes

Mailing Address

6600 Van Aalst Blvd Bldg 9250

Fort Moore, GA 319052102

Phone: 7065457308

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.