Provider Demographics
NPI:1417747056
Name:PHILIPPE, WILDNA (PA-C)
Entity type:Individual
Prefix:
First Name:WILDNA
Middle Name:
Last Name:PHILIPPE
Suffix:
Gender:
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 1:410 MEIJER DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5128
Mailing Address - Country:US
Mailing Address - Phone:855-791-7201
Mailing Address - Fax:
Practice Address - Street 1:410 MEIJER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5128
Practice Address - Country:US
Practice Address - Phone:855-791-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant