Active NPI
Kenneth Carl Wilson, MD
- Family Medicine Physician
- Louisville, KY
National Provider Identifier
1710042940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 24205
- Practice address
- 234 E Gray St
Suite 364
Louisville, KY 40202-1900 - Phone
- (502) 629-5578
- Fax
- (502) 629-5147
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 24205 | KY | Primary |
Addresses
Primary practice location
234 E Gray St
Suite 364
Louisville, KY 40202-1900
Mailing address
PO Box 35070
Louisville, KY 40232-5070
Phone (502) 629-5578
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24205 | KY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harrison Family Medicine PC | Family Medicine | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710042940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 35070",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402325070",
"telephone_number": "502-629-5578",
"fax_number": "502-629-5147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 E GRAY ST",
"address_2": "SUITE 364",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021900",
"telephone_number": "502-629-5578",
"fax_number": "502-629-5147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KENNETH",
"middle_name": "CARL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "24205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.