Individual
JENNIFER L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3050 HARRODSBURG RD, STE 100, LEXINGTON, KY 40503-2747
(859) 277-6102
(859) 977-0237
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
052858
GA
208000000X
Pediatrics Physician
41107
KY
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
41107
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135542874A
—
GA
05
—
7100028860
—
KY
05
—
G52858
—
SC
Enumeration date
08/31/2006
Last updated
01/05/2024
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