Provider Demographics
NPI:1699407841
Name:WILKINS, NATHANIEL A (PSYD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:A
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 DISTRICT ST UNIT 118
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3481
Mailing Address - Country:US
Mailing Address - Phone:989-600-9515
Mailing Address - Fax:
Practice Address - Street 1:85 KIRMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1340
Practice Address - Country:US
Practice Address - Phone:775-982-2862
Practice Address - Fax:775-982-2865
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
NVPA118103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program