Wildeman, Jacki L

Wildeman, Jacki L is an individual health care provider with primary practice located at 4007 Gateway Blvd # 100 , Newburgh IN 47630-8947. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Wildeman, Jacki L can be contacted via phone (812) 842-0907.

Contact Information

Primary practice address
4007 Gateway Blvd # 100 Newburgh IN 47630-8947
Phone: (812) 842-0907
Fax: (812) 490-7054
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71001467A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 3899P Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 309002150 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 71001467A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 28079891A Indiana

Profile Details

NPI number 1184672628
LBN Legal business name Wildeman, Jacki L
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2006
Last updated Dec 6th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184672628 NPPES
Kentucky MEDICAID 78009586
Kentucky Other 000000270530
Kentucky MEDICAID 200427140

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