Active NPI
Debra Jean Wolf, APRN
- Nurse Practitioner
- Irvine, KY
National Provider Identifier
1114904265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 3002419
- Practice address
- 275 Court St
Irvine, KY 40336-1077 - Phone
- (606) 723-2167
- Fax
- (606) 723-2112
- NPI assigned
- Dec 29, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | KY 1030153 24198 | KY | |
| Nurse Practitioner | 363L00000X | 3002419 | KY | Primary |
Addresses
Primary practice location
275 Court St
Irvine, KY 40336-1077
Mailing address
275 Court St
Irvine, KY 40336-1077
Phone (606) 723-2167
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 183919 | Other | KY | RIVERBEND GOVERNMENT |
| 35001643 | Medicaid | KY | |
| 78005014 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY 1030153 24198 | KY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elderserve, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Louisville, KY
- NPI 1982886784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436486400000",
"number": "1114904265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 COURT ST",
"city": "IRVINE",
"state": "KY",
"postal_code": "403361077",
"telephone_number": "606-723-2167",
"fax_number": "606-723-2112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 COURT ST",
"city": "IRVINE",
"state": "KY",
"postal_code": "403361077",
"telephone_number": "606-723-2167",
"fax_number": "606-723-2112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "DEBRA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-29",
"last_updated": "2015-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KY",
"license": "KY 1030153 24198",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "KY",
"license": "3002419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RIVERBEND GOVERNMENT",
"identifier": "183919",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "35001643",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "78005014",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvine, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.