Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN.CNP.024327 | OH |
NPI | 1073077020 |
---|---|
Provider Name | Kaleb Wilkins |
First Address | Philo, OH 43771-9762 |
Second Address | Malta, OH 43758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 11/05/2021 |