Provider Demographics
NPI:1316393606
Name:WILKERSON, CYTHERA (LAC)
Entity Type:Individual
Prefix:MISS
First Name:CYTHERA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W MAIN ST STE 609
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1856
Mailing Address - Country:US
Mailing Address - Phone:502-330-4233
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST STE 609
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1856
Practice Address - Country:US
Practice Address - Phone:502-330-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist