Provider Demographics
NPI:1689935660
Name:WILKERSON, ERIN L (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:L
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1196
Practice Address - Country:US
Practice Address - Phone:317-962-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004005A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201107440Medicaid
IN267030004Medicare PIN
IN201107440Medicaid
IN264430143Medicare PIN