Healthcare Provider Details

I. General information

NPI: 1548211006
Provider Name (Legal Business Name): HEATHER L WILKINSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/27/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WEISSMAN RD
LIVINGSTON MANOR NY
12758
US

IV. Provider business mailing address

PO BOX 363
CALLICOON CENTER NY
12724-0363
US

V. Phone/Fax

Practice location:
  • Phone: 454-822-2788
  • Fax:
Mailing address:
  • Phone: 402-740-5658
  • Fax: 843-419-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH0075216
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number305389
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1045
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number305389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: