Provider Demographics
NPI:1285897652
Name:WILBURN, CONNIE DENISE (ARNP)
Entity type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:DENISE
Last Name:WILBURN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-0377
Mailing Address - Country:US
Mailing Address - Phone:606-473-9838
Mailing Address - Fax:606-473-6405
Practice Address - Street 1:806 SEATON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1196
Practice Address - Country:US
Practice Address - Phone:606-473-9838
Practice Address - Fax:606-473-6405
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2737P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health