Individual
LORETTA SUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P
Contact information
Practice address
39 CUMBERLAND GAP PLZ, GRAY, KY 40734-4536
(606) 526-9005
(606) 526-8606
Mailing address
1019 CUMBERLAND FALLS HWY, SUITE B201, CORBIN, KY 40701-2735
(606) 526-9005
(606) 526-8606
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1083291
KY
363L00000X
Nurse Practitioner
Primary
3005770
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100089740
—
KY
Enumeration date
08/07/2008
Last updated
12/10/2018
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