Provider Demographics
NPI:1235326737
Name:WILKERSON, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1532 LONE OAK RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7913
Mailing Address - Country:US
Mailing Address - Phone:270-538-5880
Mailing Address - Fax:287-538-5870
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-5880
Practice Address - Fax:287-538-5870
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43494207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100165020Medicaid
KYK047860Medicare PIN