Provider Demographics
NPI:1275819617
Name:WILKINS, KELLY GRAHAM (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:GRAHAM
Last Name:WILKINS
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:NC
Mailing Address - Zip Code:28386-9333
Mailing Address - Country:US
Mailing Address - Phone:910-775-9202
Mailing Address - Fax:910-775-9224
Practice Address - Street 1:311 JUDGES RD STE 4E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005394363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily