Provider Demographics
NPI:1134505571
Name:WILKINSON, LAURA KIMBERLY (RN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KIMBERLY
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:RN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E MILLTOWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-6109
Mailing Address - Country:US
Mailing Address - Phone:330-345-6555
Mailing Address - Fax:330-345-6648
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6109
Practice Address - Country:US
Practice Address - Phone:330-345-6555
Practice Address - Fax:330-345-6648
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.211696-COA1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult