Provider Demographics
NPI:1619370087
Name:WILKERSON, ANTHONY (NP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CARRIAGE END WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-6521
Mailing Address - Country:US
Mailing Address - Phone:434-579-0935
Mailing Address - Fax:434-572-2510
Practice Address - Street 1:2232 WILBORN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1662
Practice Address - Country:US
Practice Address - Phone:434-517-3355
Practice Address - Fax:434-572-2510
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily