Individual
JARED K WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
112 LIBERTY SQ, LIBERTY, KY 42539-3392
(606) 787-5044
(606) 787-5029
Mailing address
112 LIBERTY SQ, LIBERTY, KY 42539-3392
(606) 787-5044
(606) 787-5029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32177
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64321771
—
KY
Enumeration date
01/25/2006
Last updated
11/30/2015
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