Individual
KIMBERLY SHAWN WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1530 LONE OAK RD, PADUCAH, KY 42003-7901
(270) 444-2444
Mailing address
211 SAINT FRANCIS DR, ATTN MEDICAL AFFAIRS, CAPE GIRARDEAU, MO 63703-5049
(573) 331-5583
(573) 331-5079
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2017001832
MO
363LF0000X
Family Nurse Practitioner
Primary
3011318
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100464430
—
KY
01
—
K239330
MEDICARE PTAN
KY
Enumeration date
03/25/2017
Last updated
04/19/2022
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