Provider Demographics
NPI:1306252622
Name:WILKERSON, MEREDITH WRAY (FNP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:WRAY
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:SC
Mailing Address - Zip Code:29742-5737
Mailing Address - Country:US
Mailing Address - Phone:803-627-9016
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:803-627-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily