MEDICARE: KERRY WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2704	WV
2	101YP2500X	Professional Counselor	701013642	VA
3	101YP2500X	Professional Counselor	162784	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861769614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY WHEELER

Provider Business Mailing Address
First Line	:	108 W MADISON ST
Second Line	:
City	:	LOUISA
State	:	KY
Zip	:	41230-1327
Country	:	US
Telephone Number	:	606-826-0341
Fax Number	:	606-826-0349

Provider Business Practice Location Address
First Line	:	108 W MADISON ST
Second Line	:
City	:	LOUISA
State	:	KY
Zip	:	41230-1327
Country	:	US
Telephone Number	:	606-826-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	10/05/2025

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Directions to “ KERRY WHEELER ” Practice Location

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