Healthcare Provider Details

I. General information

NPI: 1568387017
Provider Name (Legal Business Name): KELLY WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

IV. Provider business mailing address

3043 E LOBO RDG
NEW ALBANY IN
47150-9597
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-1550
  • Fax:
Mailing address:
  • Phone: 502-938-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88002178A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: