Individual
DAENA C. WILDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1036 AMBERLEY WAY, STE. A, RICHMOND, KY 40475-8979
(859) 623-4458
(859) 623-4459
Mailing address
1036 AMBERLEY WAY, STE. A, RICHMOND, KY 40475-8979
(859) 623-4458
(859) 623-4459
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
KY-0136
KY
237600000X
Audiologist-Hearing Aid Fitter
0532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
640004124
RR MEDICARE PIN
GA
01
—
CB5773
RR MEDICARE GRP
GA
01
—
K117240
MEDICARE PTAN
KY
Enumeration date
09/13/2006
Last updated
03/30/2016
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