Individual
BETHANY RAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APSS
Contact information
Practice address
333 WALLER AVE STE 250, LEXINGTON, KY 40504-2915
(859) 562-1770
Mailing address
3677 BEATEN PATH, LEXINGTON, KY 40509-8564
(859) 209-1414
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
1164221
KY
172V00000X
Community Health Worker
Primary
KCCHW12307238
KY
175T00000X
Peer Specialist
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
02/27/2018
Last updated
04/18/2025
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