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General NPI Number Information
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NPI Number | 1275819617
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Entity Type | Individual
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Provider Name | KELLY GRAHAM WILKINS FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 620 JOHNS RD
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City | LAURINBURG
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State | NC
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Zip | 28352-5128
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Country | US
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Telephone | 910-276-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 8465 SHANNON RD
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City | SHANNON
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State | NC
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Zip | 28386-9333
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Country | US
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Telephone | 910-775-9202
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Fax | 910-775-9224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5005394
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5005394
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License Number State | NC
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