Provider Demographics
NPI:1114246147
Name:WILKEY, HEATHER HENDERSON (NP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:HENDERSON
Last Name:WILKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 NICHOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2421
Mailing Address - Country:US
Mailing Address - Phone:662-459-4336
Mailing Address - Fax:
Practice Address - Street 1:706 HIGHWAY 82 W
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5028
Practice Address - Country:US
Practice Address - Phone:662-459-2181
Practice Address - Fax:662-459-2182
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05632706Medicaid