Individual
MRS. TRACEY LYNN WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-6822
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-6822
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704217231
MI
363LA2200X
Adult Health Nurse Practitioner
F309789
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043417132
—
MI
01
—
12065154
CAQH
—
01
—
P00753676
RRMEDICARE
MI
Enumeration date
07/02/2007
Last updated
03/19/2021
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