Individual
KIMBERLY M. WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8101 CLEARVISTA PKWY, SUITE 200, INDIANAPOLIS, IN 46256-4696
(317) 621-6660
(317) 621-4473
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003302
IL
363A00000X
Physician Assistant
Primary
10002145A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540022
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
DB1658
RR MEDICARE PTAN (GROUP)
IL
01
—
P01104053
RR MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P01777161
RR MEDICARE
IN
Enumeration date
02/20/2009
Last updated
11/27/2023
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