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NPI Code Detail

MEDICARE: MRS. DENISE BLAIR WILBURN

MEDICARE: MRS. DENISE BLAIR WILBURN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3004516KY
2363LF0000XFamily Nurse Practitioner4516PKY
3207QA0401XAddiction Medicine (Family Medicine) Physician71001728AIN
4363LF0000XFamily Nurse Practitioner71001728AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4K156040OTHERKYMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171001728AOTHERINLICENSE NUMBER
24526POTHERKYARNP LICENSE
33004516OTHERKYLICENSE NUMBER
51105450OTHERKYRN LICENSE

General Provider Information

NPI Number : 1417984758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DENISE BLAIR WILBURN
Provider Business Mailing Address
First Line : 2100 MARKET ST STE 101
Second Line :
City : CHARLESTOWN
State : IN
Zip : 47111-9535
Country : US
Telephone Number : 812-503-5100
Fax Number : 770-573-9513
Provider Business Practice Location Address
First Line : 1802 E 10TH ST
Second Line :
City : JEFFERSONVILLE
State : IN
Zip : 47130-6016
Country : US
Telephone Number : 812-288-2488
Fax Number : 770-573-9513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 11/08/2021

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Directions to “ MRS. DENISE BLAIR WILBURN ” Practice Location

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