Provider Demographics
NPI:1043982820
Name:WETHINGTON TELEMEDICINE LLC
Entity type:Organization
Organization Name:WETHINGTON TELEMEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:270-240-2344
Mailing Address - Street 1:3271 ALVEY PARK DR W STE H
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2467
Mailing Address - Country:US
Mailing Address - Phone:270-240-2344
Mailing Address - Fax:270-240-2160
Practice Address - Street 1:3271 ALVEY PARK DR W STE H
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2467
Practice Address - Country:US
Practice Address - Phone:270-240-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100794920Medicaid
KY7100883250Medicaid
KYS06472326Medicaid