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NPI Code Detail

MEDICARE: DONNA J WILSON APRN

MEDICARE: DONNA J WILSON APRN
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
1363LF0000XFamily Nurse Practitioner3005518KY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner3005518KY

Other Identifiers

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

General Provider Information

NPI Number : 1982872206
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA J WILSON APRN
Provider Business Mailing Address
First Line : 110 W MAIN CROSS ST
Second Line :
City : GREENVILLE
State : KY
Zip : 42345-1202
Country : US
Telephone Number : 270-216-2212
Fax Number : 270-297-8311
Provider Business Practice Location Address
First Line : 222 PHILLIP STONE WAY
Second Line :
City : CENTRAL CITY
State : KY
Zip : 42330-1929
Country : US
Telephone Number : 707-543-4942
Fax Number : 270-754-3499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2008
Last Update Date : 11/02/2023

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