Provider Demographics
NPI:1689948291
Name:WILKERSON, CHRISTINA L (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 NEW HARTFORD RD A
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-240-2305
Mailing Address - Fax:270-240-2252
Practice Address - Street 1:2851 NEW HARTFORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-240-2305
Practice Address - Fax:270-240-2252
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007369363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY363L00000XOtherTAXONOMY