Provider Demographics
NPI:1255517066
Name:WILKINSON, JOSHUA R (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5901 RILEY PARK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-4278
Mailing Address - Country:US
Mailing Address - Phone:479-763-3050
Mailing Address - Fax:479-763-3281
Practice Address - Street 1:5901 RILEY PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916
Practice Address - Country:US
Practice Address - Phone:479-763-3050
Practice Address - Fax:479-763-3281
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2019-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE62322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100047310Medicaid
KY7100047310Medicaid