Provider Demographics
NPI:1740459247
Name:WILES, DEBORAH L (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:WILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2404
Mailing Address - Country:US
Mailing Address - Phone:270-753-4616
Mailing Address - Fax:
Practice Address - Street 1:305 S 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-7859
Practice Address - Country:US
Practice Address - Phone:270-753-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000569772OtherANTHEM ID
KYP00630678OtherRAILROAD MEDICARE ID
KYP00630678OtherRAILROAD MEDICARE ID