Provider Demographics
NPI:1386812386
Name:WILKINS, TAMITHA LIN (RN, BSN)
Entity type:Individual
Prefix:
First Name:TAMITHA
Middle Name:LIN
Last Name:WILKINS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SCHOOL ST.
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757
Mailing Address - Country:US
Mailing Address - Phone:304-856-3329
Mailing Address - Fax:
Practice Address - Street 1:111 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1522
Practice Address - Country:US
Practice Address - Phone:304-856-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46666163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004145Medicaid