Healthcare Provider Details

I. General information

NPI: 1457021008
Provider Name (Legal Business Name): ANGELA MARIE WILKISON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 CRESTVIEW DR
HOLLY MI
48442-8437
US

IV. Provider business mailing address

6439 CRESTVIEW DR
HOLLY MI
48442-8437
US

V. Phone/Fax

Practice location:
  • Phone: 810-919-3005
  • Fax:
Mailing address:
  • Phone: 810-919-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704265236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: