Provider Demographics
NPI:1326286089
Name:WILKERSON, ANITA JANE (CRNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JANE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:J
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 358
Mailing Address - Street 2:JUNCTION OF HIGHWAY 371 & ROUTE 9
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-0358
Mailing Address - Country:US
Mailing Address - Phone:505-786-5291
Mailing Address - Fax:
Practice Address - Street 1:JUNCTION OF HIGHWAY 371 & ROUTE 9
Practice Address - Street 2:
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:97313
Practice Address - Country:US
Practice Address - Phone:505-786-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175091163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse