Healthcare Provider Details

I. General information

NPI: 1588546683
Provider Name (Legal Business Name): MELISSA KAY WILSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 LANE ALLEN RD
LEXINGTON KY
40504-3658
US

IV. Provider business mailing address

17865 OLD PALESTINE RD
CROFTON KY
42217-8368
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9081
  • Fax:
Mailing address:
  • Phone: 270-889-3616
  • Fax: 270-889-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4043490
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: