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General NPI Number Information
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NPI Number | 1760492185
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Entity Type | Individual
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Provider Name | SHARON LYNN WILT M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1201 PLEASANT VALLEY RD FL 7
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City | OWENSBORO
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State | KY
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Zip | 42303-9811
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Country | US
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Telephone | 270-417-4705
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Fax | 270-417-4709
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Provider Business Mailing Address
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Address Line | 521 RIVER OVERLOOK
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City | FORSYTH
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State | GA
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Zip | 31029-4898
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Country | US
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Telephone | 601-942-0179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53549
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 66842
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License Number State | GA
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