Provider Demographics
NPI:1194542431
Name:WILKERSON, JUSTINA LYNN
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:LYNN
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 1:119 MYRA BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3750
Mailing Address - Country:US
Mailing Address - Phone:502-316-3123
Mailing Address - Fax:
Practice Address - Street 1:119 MYRA BARNES AVE
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3750
Practice Address - Country:US
Practice Address - Phone:502-316-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist