Provider Demographics
NPI:1588021877
Name:GAITHER-WILSON, JOLYNN (APRN)
Entity type:Individual
Prefix:
First Name:JOLYNN
Middle Name:
Last Name:GAITHER-WILSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JOLYNN
Other - Middle Name:
Other - Last Name:GAITHER-CRENSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1941 BISHOP LN STE 506
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1969
Mailing Address - Country:US
Mailing Address - Phone:502-203-1084
Mailing Address - Fax:502-371-8760
Practice Address - Street 1:1941 BISHOP LN STE 506
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1969
Practice Address - Country:US
Practice Address - Phone:502-203-1084
Practice Address - Fax:502-371-8760
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009994363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily