NPIMap

Individual provider Active NPI

Jennifer Wiles Nelson, DO

  • Family Medicine Physician
  • Paducah, KY
National Provider Identifier
1336222512
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02847 Issued in KY
Practice address
2850 Lone Oak Rd
Suite 4
Paducah, KY 42003-8043
Phone
(270) 554-3904
Fax
(270) 534-8928
NPI assigned
Oct 23, 2006
Last updated
Sep 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02847 KY Primary

Addresses

Primary practice location

2850 Lone Oak Rd
Suite 4
Paducah, KY 42003-8043

Mailing address

2850 Lone Oak Rd
Suite 4
Paducah, KY 42003-8043
Phone (270) 205-1394

Other identifiers 1

IdentifierTypeStateIssuer
64068638MedicaidKY

Other names 1

  • Mrs. Jennifer Wiles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050722000675 KY Practitioner - Family Practice 3173550936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Total Life Care, PLLCGroup PAC ID 6800786633, 4 clinicians

Practice addresses (Care Compare)

2850 Lone Oak Rd
Suite 4
Paducah, KY 42003-8043
Phone (270) 554-3904

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Total Life Care, PLLC Family Medicine CurrentSince Jul 1, 2007 Accepting new patients
Dr. Butler & Associates, PLLC Past Accepting new patients

Locations

2850 Lone Oak Rd
Ste 4
Paducah, KY 42003
Phone (270) 554-3904

Interoperability endpoints

  • Direct secure messaging: jennifer.nelson.1@29556.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1336222512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 LONE OAK RD",
            "address_2": "SUITE 4",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420038043",
            "telephone_number": "270-205-1394",
            "fax_number": "270-534-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 LONE OAK RD",
            "address_2": "SUITE 4",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420038043",
            "telephone_number": "270-554-3904",
            "fax_number": "270-534-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JENNIFER",
        "middle_name": "WILES",
        "name_prefix": "Mrs.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64068638",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WILES",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Paducah, KY

Sources for this page

Verify at the official NPI Registry.