Jacki L Wildeman, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71001467A Issued in IN

Practice address

4007 Gateway Blvd # 100
Newburgh, IN 47630-8947

Phone

(812) 842-0907

Fax

(812) 490-7054

NPI assigned

May 5, 2006

Last updated

Dec 6, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

82.62 of 100Reported as group

Quality

72.6

Promoting interoperability

100

Improvement activities

40

Cost

69.46

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1184672628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 GATEWAY BLVD STE 2120",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476309460",
            "telephone_number": "812-842-0907",
            "fax_number": "812-464-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 GATEWAY BLVD # 100",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308947",
            "telephone_number": "812-842-0907",
            "fax_number": "812-490-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEMAN",
        "first_name": "JACKI",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001467A",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3899P",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "309002150",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71001467A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "28079891A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200427140",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000270530",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78009586",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coty L Wichman, BCBA
• Safiya Wickware, APRN
• Sarah E Wieligman, NP
• Jonathan Hunter Wigington, DC
• Riley Wike
• Timia Wilhite, RBT
• Tom Wilhite
• Danica Ashley Wilking, M.D.
• Kevin Norbert Wilking, M.D.
• Mirielle Wilkinson

• Nurse Practitioner in Newburgh, IN
• Providers in Newburgh, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.