Provider Demographics
NPI:1467164657
Name:WILSON, WHITNEY (APRN-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BERTIE HAMMONDS RD
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-9047
Mailing Address - Country:US
Mailing Address - Phone:606-743-2458
Mailing Address - Fax:
Practice Address - Street 1:73 BERTIE HAMMONDS RD
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-9047
Practice Address - Country:US
Practice Address - Phone:606-743-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF11220970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily