Provider Demographics
NPI:1306906250
Name:WILKERSON, EVELYN (FNP)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
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 1:5209 LAKE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331
Mailing Address - Country:US
Mailing Address - Phone:404-629-9540
Mailing Address - Fax:
Practice Address - Street 1:TIPTON MEDICAL CLINIC
Practice Address - Street 2:575 N THOMPSON RD
Practice Address - City:TIPTON
Practice Address - State:CA
Practice Address - Zip Code:93272-9756
Practice Address - Country:US
Practice Address - Phone:559-752-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN043510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily