Provider Demographics
NPI:1326595281
Name:WILKINSON, RACHEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 STUDT AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7052
Mailing Address - Country:US
Mailing Address - Phone:314-625-8454
Mailing Address - Fax:
Practice Address - Street 1:2108 SCHUETZ RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3538
Practice Address - Country:US
Practice Address - Phone:314-625-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025924163W00000X
MO2017035852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017035852OtherMISSOURI STATE BOARD OF NURSING
MOF09171434OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
MO1326595231OtherFAMILY NURSE PRACTITIONER