Active NPI
Melissa Ann Wilder
- Contractor
- Richmond, KY
National Provider Identifier
1821207937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 02032
- Practice address
- 133 Peacock Rd
Richmond, KY 40475-9338 - Phone
- (859) 625-0087
- Fax
- (859) 625-0087
- NPI assigned
- May 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 02032 | KY | Primary |
Addresses
Primary practice location
133 Peacock Rd
Richmond, KY 40475-9338
Mailing address
133 Peacock Rd
Richmond, KY 40475-9338
Phone (859) 625-0087
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02032 | KY | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821207937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 PEACOCK RD",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404759338",
"telephone_number": "859-625-0087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 PEACOCK RD",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404759338",
"telephone_number": "859-625-0087",
"fax_number": "859-625-0087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "MELISSA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "KY",
"license": "02032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, 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.