Provider Demographics
NPI:1225798473
Name:WILKINSON, MELODY S (AGPCNP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:S
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410823
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-0823
Mailing Address - Country:US
Mailing Address - Phone:314-432-5144
Mailing Address - Fax:314-432-2400
Practice Address - Street 1:300 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-9700
Practice Address - Country:US
Practice Address - Phone:406-693-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021050328363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology