Healthcare Provider Details

I. General information

NPI: 1770061301
Provider Name (Legal Business Name): DANIELLE WILSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DRIVE
EDGEWOOD KY
41017-5403
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-5651
  • Fax:
Mailing address:
  • Phone: 859-429-5188
  • Fax: 859-301-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012221
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: