Healthcare Provider Details

I. General information

NPI: 1346686227
Provider Name (Legal Business Name): CARLA MICHELLE WILSON RN, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA MICHELLE ERBY RN, APRN-CNP

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 09/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 S. HWY 27
SOMERSET KY
42501
US

IV. Provider business mailing address

2441 S. HWY 27
SOMERSET KY
42501
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-4068
  • Fax: 606-678-0814
Mailing address:
  • Phone: 606-677-4068
  • Fax: 859-236-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008066
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1123818
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: