Healthcare Provider Details

I. General information

NPI: 1467164657
Provider Name (Legal Business Name): WHITNEY WILSON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 69
LA GRANGE KY
40031-0069
US

IV. Provider business mailing address

PO BOX 69
LA GRANGE KY
40031-0069
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-0170
  • Fax:
Mailing address:
  • Phone: 502-222-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11220970
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: