Provider Demographics
NPI:1073077020
Name:WILKINS, KALEB (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 VIRGINIA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:OH
Mailing Address - Zip Code:43771-9762
Mailing Address - Country:US
Mailing Address - Phone:740-891-0374
Mailing Address - Fax:
Practice Address - Street 1:859 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758
Practice Address - Country:US
Practice Address - Phone:740-962-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.386473163W00000X
OHAPRN.CNP.024327363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse