Provider Demographics
NPI:1609380880
Name:WILKERSON, LESLEY ELIZABETH (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ELIZABETH
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7268
Mailing Address - Country:US
Mailing Address - Phone:662-335-4105
Mailing Address - Fax:662-378-2879
Practice Address - Street 1:1997 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7268
Practice Address - Country:US
Practice Address - Phone:662-335-4105
Practice Address - Fax:662-378-2879
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily