Provider Demographics
NPI:1821765744
Name:WILKINSON, KIMBERLY LYNNETTE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNETTE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRIDGE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1222
Mailing Address - Country:US
Mailing Address - Phone:434-470-5863
Mailing Address - Fax:
Practice Address - Street 1:519 GARDEN RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:VA
Practice Address - Zip Code:23964-3020
Practice Address - Country:US
Practice Address - Phone:434-579-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001251755163W00000X
VA0024182558363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily