Healthcare Provider Details

I. General information

NPI: 1437075736
Provider Name (Legal Business Name): BILLY BRIAN WILSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MARIE LANGDON DR
MANCHESTER KY
40962-6329
US

IV. Provider business mailing address

56 MARIE LANGDON DR
MANCHESTER KY
40962-6329
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-4080
  • Fax:
Mailing address:
  • Phone: 606-598-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4059643
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: