Provider Demographics
NPI:1700986577
Name:WILKEY, DARLENE SMITH (CNP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:SMITH
Last Name:WILKEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2723 MINNESOTA AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2223
Mailing Address - Country:US
Mailing Address - Phone:218-751-2517
Mailing Address - Fax:
Practice Address - Street 1:705 5TH ST NW
Practice Address - Street 2:SUITE D
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2932
Practice Address - Country:US
Practice Address - Phone:218-444-7186
Practice Address - Fax:218-444-2460
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1417935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240206Medicare Oscar/Certification
MNQ46159Medicare UPIN