Provider Demographics
NPI:1083377873
Name:WILKERSON, JESSICA ANN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7720 S BROADWAY STE 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2634
Mailing Address - Country:US
Mailing Address - Phone:720-922-6240
Mailing Address - Fax:720-922-6241
Practice Address - Street 1:7720 S BROADWAY STE 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2634
Practice Address - Country:US
Practice Address - Phone:720-922-6240
Practice Address - Fax:720-922-6241
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997018-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000198558Medicaid