Basic Information
| Provider Information | |||||||||
| NPI: | 1851620504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILDING | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 DIXIE HWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029686226 | ||||||||
| FaxNumber: | 5029665562 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 OUTER LOOP | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402194056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029686226 | ||||||||
| FaxNumber: | 5029665562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1089016 | KY | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN9170715 | FL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 6304P | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 3006304 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7100097780 | 05 | KY | MEDICAID |