Provider Demographics
NPI:1346686227
Name:WILSON, CARLA MICHELLE (RN, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, APRN-CNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MICHELLE
Other - Last Name:ERBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APRN-CNP
Mailing Address - Street 1:2441 S. HWY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-677-4068
Mailing Address - Fax:859-236-0320
Practice Address - Street 1:2441 S. HWY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-677-4068
Practice Address - Fax:606-678-0814
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1123818163W00000X
KY3008066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50054186OtherPASSPORT HEALTH PLAN
KY7100251570Medicaid
KY50054186OtherPASSPORT HEALTH PLAN