Healthcare Provider Details

I. General information

NPI: 1912704412
Provider Name (Legal Business Name): KIM WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VISTA RD
NORFOLK NE
68701-6721
US

IV. Provider business mailing address

305 N 4TH ST
NORFOLK NE
68701-4003
US

V. Phone/Fax

Practice location:
  • Phone: 402-316-8297
  • Fax:
Mailing address:
  • Phone: 402-371-1147
  • Fax: 402-371-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: