Provider Demographics
NPI:1457053589
Name:WILKINSON, KAITLYN CASAL (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:CASAL
Last Name:WILKINSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:CASAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1080 NEAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0944
Mailing Address - Country:US
Mailing Address - Phone:931-520-1529
Mailing Address - Fax:
Practice Address - Street 1:1080 NEAL ST STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0944
Practice Address - Country:US
Practice Address - Phone:931-520-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant