Provider Demographics
NPI:1841753449
Name:WILKERSON, STEPHON DIONTE (BS, PP)
Entity Type:Individual
Prefix:
First Name:STEPHON
Middle Name:DIONTE
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:BS, PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 HILLTOP RD APT J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5255
Mailing Address - Country:US
Mailing Address - Phone:336-470-1712
Mailing Address - Fax:
Practice Address - Street 1:5030 HILLTOP RD APT J
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5255
Practice Address - Country:US
Practice Address - Phone:336-470-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide