Provider Demographics
NPI:1497563811
Name:WILKERSON, TEENA (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:TEENA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 PATTERSON CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6683
Mailing Address - Country:US
Mailing Address - Phone:443-326-2353
Mailing Address - Fax:
Practice Address - Street 1:7511 PATTERSON CT
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6683
Practice Address - Country:US
Practice Address - Phone:443-326-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered