Provider Demographics
NPI:1487144259
Name:WOLFE, WILLIAM PAUL (APRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:WOLFE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 DOGPATCH TRADING CTR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8292
Mailing Address - Country:US
Mailing Address - Phone:606-877-1352
Mailing Address - Fax:606-877-1356
Practice Address - Street 1:94 DOGPATCH TRADING CTR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8292
Practice Address - Country:US
Practice Address - Phone:606-877-1352
Practice Address - Fax:606-877-1356
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner