Provider Demographics
NPI:1952137184
Name:WILKERSON, JAMEELAH
Entity type:Individual
Prefix:
First Name:JAMEELAH
Middle Name:
Last Name:WILKERSON
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 1:6415 S FORT APACHE RD # 1885-20
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6744
Mailing Address - Country:US
Mailing Address - Phone:678-477-3168
Mailing Address - Fax:
Practice Address - Street 1:6415 S FORT APACHE RD # 1885-20
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6744
Practice Address - Country:US
Practice Address - Phone:678-477-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5841172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker