Provider Demographics
NPI:1427090372
Name:WILKERSON, MARIA LYNN (APN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E STADIUM
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753
Mailing Address - Country:US
Mailing Address - Phone:870-234-5995
Mailing Address - Fax:870-234-0278
Practice Address - Street 1:211 E STADIUM
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753
Practice Address - Country:US
Practice Address - Phone:870-234-5995
Practice Address - Fax:870-234-0278
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01690163W00000X
ARA001690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150702758Medicaid
ARA01690OtherSTATE LICENSURE
AR5X449Medicare ID - Type Unspecified
ARA01690OtherSTATE LICENSURE