Provider Demographics
NPI:1821346420
Name:WILKERSON, JANET SOMI
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SOMI
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:9551 DEER TRACK RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7048
Mailing Address - Country:US
Mailing Address - Phone:513-485-1055
Mailing Address - Fax:
Practice Address - Street 1:9551 DEER TRACK RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7048
Practice Address - Country:US
Practice Address - Phone:513-485-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148675376G00000X
OH52085163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN/AMedicaid
OH1821346420Medicaid