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General NPI Number Information
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NPI Number | 1699152348
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Entity Type | Organization
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Legal Business Name | WHEELER MEDICAL
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 742 E MAIN ST STE B
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City | GLASGOW
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State | KY
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Zip | 42141
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Country | US
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Telephone | 270-659-0717
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Fax | 270-659-2660
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Provider Business Mailing Address
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Address Line | 742 E MAIN ST STE B
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City | GLASGOW
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State | KY
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Zip | 42141
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Country | US
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Telephone | 270-659-0717
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Fax | 270-659-2660
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALYSIA G WHEELER
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Credential | APRN
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Telephone | 270-659-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3007578
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License Number State | KY
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