Healthcare Provider Details

I. General information

NPI: 1962319251
Provider Name (Legal Business Name): ADAIRA RIANNE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BAYVIEW DR
RICHMOND KY
40475-7511
US

IV. Provider business mailing address

116 BAYVIEW DR
RICHMOND KY
40475-7511
US

V. Phone/Fax

Practice location:
  • Phone: 859-575-1890
  • Fax: 859-957-1890
Mailing address:
  • Phone: 859-575-1890
  • Fax: 859-957-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number398658
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: