Provider Demographics
NPI:1003835455
Name:WILSHERE, REBECCA AGNES (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:AGNES
Last Name:WILSHERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5561
Mailing Address - Country:US
Mailing Address - Phone:859-282-1241
Mailing Address - Fax:859-282-7087
Practice Address - Street 1:7309 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5561
Practice Address - Country:US
Practice Address - Phone:859-282-1241
Practice Address - Fax:859-282-7087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64127897Medicaid
KYI22183Medicare UPIN