Provider Demographics
NPI:1699152348
Name:WHEELER MEDICAL
Entity type:Organization
Organization Name:WHEELER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-659-0717
Mailing Address - Street 1:742 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-659-0717
Mailing Address - Fax:270-659-2660
Practice Address - Street 1:742 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-659-0717
Practice Address - Fax:270-659-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000925692OtherANTHEM