Provider Demographics
NPI:1982872206
Name:WILSON, DONNA J (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:WELBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1202
Mailing Address - Country:US
Mailing Address - Phone:270-216-2212
Mailing Address - Fax:270-297-8311
Practice Address - Street 1:222 PHILLIP STONE WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1929
Practice Address - Country:US
Practice Address - Phone:707-543-4942
Practice Address - Fax:270-754-3499
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005518363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100042750Medicaid
KYK162850Medicare PIN