Individual
WILLIAM WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4001 DUTCHMANS LN, LOUISVILLE, KY 40207-4714
(502) 447-8786
(502) 447-8623
Mailing address
9152 TAYLORSVILLE RD # 276, LOUISVILLE, KY 40299-1752
(502) 447-8786
(502) 447-8623
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300037370
—
IN
05
—
7100643770
—
KY
Enumeration date
09/04/2019
Last updated
09/21/2023
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