Provider Demographics
NPI:1598504086
Name:WILKERSON, CHANDRA
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MEHERRIN
Mailing Address - State:VA
Mailing Address - Zip Code:23954-2313
Mailing Address - Country:US
Mailing Address - Phone:434-808-5577
Mailing Address - Fax:
Practice Address - Street 1:1105 W 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974-4522
Practice Address - Country:US
Practice Address - Phone:434-808-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider