Provider Demographics
NPI:1720872864
Name:WILKINSON, NATHAN EDWARD
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:EDWARD
Last Name:WILKINSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 SPANISH BAY CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4481
Mailing Address - Country:US
Mailing Address - Phone:979-977-6347
Mailing Address - Fax:
Practice Address - Street 1:5101 SPANISH BAY CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4481
Practice Address - Country:US
Practice Address - Phone:979-977-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator