Provider Demographics
NPI:1588685937
Name:WILKINSON, JOSEPH MICHAEL (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 GLENDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4402
Mailing Address - Country:US
Mailing Address - Phone:800-243-0566
Mailing Address - Fax:252-243-1347
Practice Address - Street 1:3516 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9495
Practice Address - Country:US
Practice Address - Phone:800-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02848207N00000X, 363L00000X
NC5001563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003944Medicaid
NCPENDINGOtherTRICARE PROVIDE NUMBER
Q47118Medicare UPIN
NCPENDINGOtherTRICARE PROVIDE NUMBER
VA012258V21Medicare PIN
NC2592869AMedicare PIN
VA0142255V20Medicare PIN