Healthcare Provider Details

I. General information

NPI: 1306767389
Provider Name (Legal Business Name): KIERA WILKERSON-JACKSON RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 DOGWOOD LN
CARMEL IN
46032-9629
US

IV. Provider business mailing address

3431 FOREST TER
ANDERSON IN
46013-5257
US

V. Phone/Fax

Practice location:
  • Phone: 317-498-1171
  • Fax: 317-219-0879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71018652A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: