Provider Demographics
NPI:1134679806
Name:WILDER, JAMIE NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICOLE
Last Name:WILDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 HOSPITAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7363
Mailing Address - Country:US
Mailing Address - Phone:606-545-5500
Mailing Address - Fax:606-545-5511
Practice Address - Street 1:80 HOSPITAL DR STE 2
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7363
Practice Address - Country:US
Practice Address - Phone:606-545-5500
Practice Address - Fax:606-545-5511
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010435363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner