Healthcare Provider Details

I. General information

NPI: 1346606860
Provider Name (Legal Business Name): REGINA DAWN WILKERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 LAKEVIEW DR
PADUCAH KY
42001-5619
US

IV. Provider business mailing address

67 LAKEVIEW DR
PADUCAH KY
42001-5619
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-8373
  • Fax: 270-554-8987
Mailing address:
  • Phone: 270-554-8373
  • Fax: 270-554-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3010183
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3010183
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: