Provider Demographics
NPI:1912051020
Name:WILKERSON, PATRICIA L (RPT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FERRANTE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1473
Mailing Address - Country:US
Mailing Address - Phone:413-774-7988
Mailing Address - Fax:413-773-7322
Practice Address - Street 1:7 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1841
Practice Address - Country:US
Practice Address - Phone:413-774-7988
Practice Address - Fax:413-773-7322
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000038823OtherBMC HEALTHNET
P00307607OtherRAILROAD MEDICARE
0042240OtherNEIGHBORHOOD HEALTH PLAN
MA0381063Medicaid
467554OtherTUFTS
MAWIY66339OtherBLUE CROSS/BLUE SHIELD
MAWIY66339OtherBLUE CROSS/BLUE SHIELD