Provider Demographics
NPI:1548211006
Name:WILKINSON, HEATHER L (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:CALLICOON CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12724-0363
Mailing Address - Country:US
Mailing Address - Phone:402-740-5658
Mailing Address - Fax:843-419-7067
Practice Address - Street 1:143 WEISSMAN RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758
Practice Address - Country:US
Practice Address - Phone:454-822-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0075216207L00000X
NY305389207Q00000X, 202D00000X
SC1045208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548211006OtherNPI
NE278973Medicare PIN
39-02145OtherSHARE ADVANTAGE
IA1462812Medicaid
IAI15516Medicare UPIN
IA0462812Medicaid
NE100249951-00Medicaid
NE247251OtherMLDCH & MUTUAL OF OMAHA
NE39-02146OtherSHAREADVANTAGE
IAI15459Medicare PIN
P00233967OtherRR MEDICARE IOWA
NE100251147-00Medicaid