Healthcare Provider Details

I. General information

NPI: 1619473873
Provider Name (Legal Business Name): NATHAN WHEELER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S WASHINGTON ST STE C
KOKOMO IN
46901-4601
US

IV. Provider business mailing address

138 N DIXON RD
KOKOMO IN
46901-4154
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-6735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21608
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number21608
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21608
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71008075A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number21608
License Number StateSC
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008075A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: