Provider Demographics
NPI:1982179404
Name:WILSON, JENNIFER RACHEL (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHEL
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-0028
Mailing Address - Country:US
Mailing Address - Phone:606-376-9700
Mailing Address - Fax:606-376-9703
Practice Address - Street 1:2157 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-6297
Practice Address - Country:US
Practice Address - Phone:606-376-9700
Practice Address - Fax:606-376-9703
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012538363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3012538OtherKY BOARD OF NURSING
TXF07182064OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD