Provider Demographics
NPI:1942409511
Name:WILBURN, BRENDA KAYE (DRPH, APRN)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAYE
Last Name:WILBURN
Suffix:
Gender:F
Credentials:DRPH, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 UNIVERSITY BLVD
Mailing Address - Street 2:112 ALLIE YOUNG HALL
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1684
Mailing Address - Country:US
Mailing Address - Phone:606-783-2055
Mailing Address - Fax:606-783-9106
Practice Address - Street 1:150 UNIVERSITY BLVD
Practice Address - Street 2:112 ALLIE YOUNG HALL
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1684
Practice Address - Country:US
Practice Address - Phone:606-783-2055
Practice Address - Fax:606-783-9106
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100034230Medicaid
KYK028820Medicare PIN