| NPI | 1841722980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASE WILSON Owner 502-316-9425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 49577) |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2020-08-24 |