Provider Demographics
NPI:1649849019
Name:WILKINSON, KATHERYN
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-2624
Mailing Address - Country:US
Mailing Address - Phone:815-590-2717
Mailing Address - Fax:
Practice Address - Street 1:102 S HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3013
Practice Address - Country:US
Practice Address - Phone:815-285-5875
Practice Address - Fax:815-285-5886
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.475810163W00000X
IL209025949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse