Provider Demographics
NPI:1487108411
Name:WILSON, NICOLE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 HARRODSBURG RD STE 125
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3543
Mailing Address - Country:US
Mailing Address - Phone:859-608-0562
Mailing Address - Fax:
Practice Address - Street 1:200 SKYWATCH DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2540
Practice Address - Country:US
Practice Address - Phone:615-425-4246
Practice Address - Fax:615-425-4265
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily