Individual
AMBER FORTUNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 E CHESTNUT ST BLDG SUITE303, LOUISVILLE, KY 40202-1831
(502) 629-5552
(502) 629-3132
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 272-5134
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC013
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2020
Last updated
09/16/2024
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