Provider Demographics
NPI:1164069969
Name:WILKERSON, MORGAN
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WEAVER CIR
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9014
Mailing Address - Country:US
Mailing Address - Phone:501-581-9561
Mailing Address - Fax:
Practice Address - Street 1:41 WEAVER CIR
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9014
Practice Address - Country:US
Practice Address - Phone:501-581-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner