Provider Demographics
NPI:1235840315
Name:WHEELER, MERCEDES (NP)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 TATUMSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044-9123
Mailing Address - Country:US
Mailing Address - Phone:502-541-9885
Mailing Address - Fax:
Practice Address - Street 1:2045 TATUMSVILLE HWY
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42044-9123
Practice Address - Country:US
Practice Address - Phone:502-541-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner