Provider Demographics
NPI:1871974857
Name:WILDER, KERRIE (RN,MS,CNM)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:RN,MS,CNM
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:
Other - Last Name:TOLLERUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,MS,CNM
Mailing Address - Street 1:304 W KIRKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6821
Mailing Address - Country:US
Mailing Address - Phone:708-768-1470
Mailing Address - Fax:800-308-0813
Practice Address - Street 1:301 S PERIMETER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4128
Practice Address - Country:US
Practice Address - Phone:615-478-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309014176B00000X
MI4704287176176B00000X
TN35381363LP0808X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife