Healthcare Provider Details

I. General information

NPI: 1578616405
Provider Name (Legal Business Name): WILKERSON CONSULTING PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N REED ST
COLUMBIA KY
42728-1356
US

IV. Provider business mailing address

127 N REED ST
COLUMBIA KY
42728-1356
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-5351
  • Fax: 270-384-6971
Mailing address:
  • Phone: 270-384-5351
  • Fax: 270-384-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number430001240
License Number StateKY

VIII. Authorized Official

Name: MR. KEN M. WILKERSON
Title or Position: DIRECTOR
Credential:
Phone: 270-384-5351