Provider Demographics
NPI:1427579374
Name:WILKEN, PAUL MICHAEL (PMHNP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:WILKEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18651 WEBSTER CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3948
Mailing Address - Country:US
Mailing Address - Phone:531-272-8322
Mailing Address - Fax:
Practice Address - Street 1:18651 WEBSTER CIR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3948
Practice Address - Country:US
Practice Address - Phone:531-272-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112259363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health