Provider Demographics
NPI:1326832031
Name:WILKERSON, PAUL D (SERVICE PROVIDER)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:WILKERSON
Suffix:
Gender:
Credentials:SERVICE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 COUNTY ROAD 203
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-8275
Mailing Address - Country:US
Mailing Address - Phone:417-372-0114
Mailing Address - Fax:
Practice Address - Street 1:181 COUNTY ROAD 203
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606-8275
Practice Address - Country:US
Practice Address - Phone:417-372-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker