=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588546683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA KAY WILSON PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 LANE ALLEN RD
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-483-9081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17865 OLD PALESTINE RD
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42217-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-889-3616
-----------------------------------------------------
Fax | 270-889-3616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4043490
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------