Individual
JAMES DYLAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
(502) 852-3762
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
137171
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3017833
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300063916
—
IN
05
—
7100824560
—
KY
Enumeration date
05/31/2022
Last updated
07/18/2022
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