Provider Demographics
NPI:1013231786
Name:WILKERSON, JENNIFER KAYE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAYE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PADUCAH RD STE B
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3616
Mailing Address - Country:US
Mailing Address - Phone:270-804-7408
Mailing Address - Fax:866-985-7514
Practice Address - Street 1:1019 PADUCAH RD STE B
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-3616
Practice Address - Country:US
Practice Address - Phone:270-804-7408
Practice Address - Fax:866-985-7514
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006410 GRP363L00000X
KY6410P363L00000X
KY3006410363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY618423OtherWELLCARE
KY7100113990Medicaid
KY00587647OtherANTHEM MEDICAID
KY3006410OtherNEW APRN # 01-10-11
KY618423OtherWELLCARE