Provider Demographics
NPI:1982788063
Name:WHEELER, KATHY JUSTICE (PHD, CFNP, MSN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JUSTICE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PHD, CFNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BEVINS LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6178
Mailing Address - Country:US
Mailing Address - Phone:859-323-9333
Mailing Address - Fax:
Practice Address - Street 1:202 BEVINS LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6178
Practice Address - Country:US
Practice Address - Phone:859-323-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7800304300Medicaid
K088440Medicare PIN