Provider Demographics
NPI:1902810906
Name:WILDER, PAULA F (FNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:F
Last Name:WILDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 GLENWILD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6011
Mailing Address - Country:US
Mailing Address - Phone:901-857-8925
Mailing Address - Fax:
Practice Address - Street 1:5547 GLENWILD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6011
Practice Address - Country:US
Practice Address - Phone:901-857-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73605163WG0000X
TN0000006154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3904435Medicaid
TN3904435Medicaid
P16098Medicare UPIN