Provider Demographics
NPI:1619647468
Name:WILHELMUS, KURT EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:EDWARD
Last Name:WILHELMUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LANTERN WAY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9009
Mailing Address - Country:US
Mailing Address - Phone:859-576-8037
Mailing Address - Fax:
Practice Address - Street 1:535 WELLINGTON WAY STE 140
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1387
Practice Address - Country:US
Practice Address - Phone:859-636-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPA2918OtherSTATE PHYSICIAN ASSISTANT LICENSE