Provider Demographics
NPI:1205298320
Name:WHEELER, AUDRA (RN, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3939
Mailing Address - Country:US
Mailing Address - Phone:740-349-7511
Mailing Address - Fax:740-414-4050
Practice Address - Street 1:15 N 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5550
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:740-414-4050
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363492163W00000X
OH022633363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2892946OtherNYAP