Healthcare Provider Details

I. General information

NPI: 1326387556
Provider Name (Legal Business Name): KRISTIN JEAN WILKERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

200 S WELLS RD #200
VENTURA CA
93004-1377
US

V. Phone/Fax

Practice location:
  • Phone: 805-445-7800
  • Fax:
Mailing address:
  • Phone: 805-659-1740
  • Fax: 805-659-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR876185
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000211
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: