Individual
KELLY A. WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2510 COMMONS BLVD STE 270, BEAVERCREEK, OH 45431-3834
(937) 431-0200
(937) 431-0488
Mailing address
3535 PENTAGON BLVD STE 220, BEAVERCREEK, OH 45431-1705
(937) 429-7350
(937) 431-2623
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
COA.16865-NM
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105065
GROUP MEDICAID
OH
05
—
0135156
—
OH
01
—
1184652539
GROUP NPI
OH
01
—
9934723
GROUP PTAN
OH
Enumeration date
06/01/2015
Last updated
04/20/2023
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