Individual
JEREMY LEE WILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
9431 COUNTY ROAD 403, CHARLESTOWN, IN 47111-8946
(812) 256-6391
Mailing address
9431 COUNTY ROAD 403, CHARLESTOWN, IN 47111-8946
(812) 256-6391
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71005761A
IN
363LF0000X
Family Nurse Practitioner
Primary
28165750A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28165750A
INDIANA LICENSE NUMBER
IN
01
—
F0915751
AANP CERTIFICATION
IN
Enumeration date
09/24/2015
Last updated
11/06/2023
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