Provider Demographics
NPI:1376781450
Name:WHEELER, ALLISON LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:WHEELER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLSION
Other - Middle Name:LEIGH
Other - Last Name:MEZOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:502-583-2120
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006453363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100155330Medicaid
IN201019870Medicaid
KY000057119GOtherHUMANA - NNIKY
KY0323040OtherCIGNA - NNIKY
KY124241OtherSIHO - NNIKY
KY50032280OtherPASSPORT/PASSPORT ADVANTAGE - NNIKY
KY000000707748OtherANTHEM - NNIKY
IN201019870Medicaid