Healthcare Provider Details

I. General information

NPI: 1629972997
Provider Name (Legal Business Name): KATLINE WILKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 DIAL DR
KENNETT MO
63857-1205
US

IV. Provider business mailing address

934 DIAL DR
KENNETT MO
63857-1205
US

V. Phone/Fax

Practice location:
  • Phone: 573-559-6812
  • Fax:
Mailing address:
  • Phone: 573-559-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021043113
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: