Provider Demographics
NPI:1578964987
Name:WILKINS, KRISTIN N (APN-CNS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:WILKINS
Suffix:
Gender:F
Credentials:APN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-661-2368
Mailing Address - Fax:309-662-9709
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 320
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-661-2368
Practice Address - Fax:309-662-9709
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011656364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health