Provider Demographics
NPI:1932423316
Name:WILKINSON, VICKI T (CRNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:T
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 BARNES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3177
Mailing Address - Country:US
Mailing Address - Phone:724-832-9190
Mailing Address - Fax:724-978-0544
Practice Address - Street 1:8800 BARNES LAKE RD
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3177
Practice Address - Country:US
Practice Address - Phone:724-832-9190
Practice Address - Fax:724-978-0544
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010578363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103078921Medicaid
483637Medicare PIN