MEDICARE: DR. HEATHER L WILKINSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	H0075216	MD
2	207Q00000X	Family Medicine Physician	305389	NY
3	208D00000X	General Practice Physician	1045	SC
4	202D00000X	Integrative Medicine Physician	305389	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548211006	OTHER		NPI

General Provider Information

NPI Number	:	1548211006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER L WILKINSON DO

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	CALLICOON CENTER
State	:	NY
Zip	:	12724-0363
Country	:	US
Telephone Number	:	402-740-5658
Fax Number	:	843-419-7067

Provider Business Practice Location Address
First Line	:	143 WEISSMAN RD
Second Line	:
City	:	LIVINGSTON MANOR
State	:	NY
Zip	:	12758
Country	:	US
Telephone Number	:	454-822-2788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/27/2023

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