Healthcare Provider Details

I. General information

NPI: 1285739417
Provider Name (Legal Business Name): DAENA C. WILDS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MOUNT VERNON DR STE 202
GEORGETOWN KY
40324-1526
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 502-867-7806
  • Fax: 502-867-7836
Mailing address:
  • Phone: 859-258-6200
  • Fax: 859-258-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0532
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number100082
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: