Provider Demographics
NPI:1750475794
Name:WILKERSON, PATSY J (MA)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:J
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:1014 JOHNSTOWN ROAD
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1128
Mailing Address - Country:US
Mailing Address - Phone:304-252-4433
Mailing Address - Fax:304-252-1703
Practice Address - Street 1:1014 JOHNSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25802-4940
Practice Address - Country:US
Practice Address - Phone:304-252-4433
Practice Address - Fax:304-252-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163722000Medicaid
WV00172507OtherBC B SHIELD
WVW1CP19921Medicare ID - Type Unspecified