Individual
HEATHER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 LEGACY DR, BEREA, KY 40403-9594
(859) 986-2323
Mailing address
1010 MAIN ST S, MC KEE, KY 40447-7089
(859) 626-7700
(859) 626-7890
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3010517
KY
Other
Enumeration date
07/12/2016
Last updated
07/13/2016
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