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General NPI Number Information
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NPI Number | 1952968638
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Entity Type | Individual
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Provider Name | OLIVIA SUSAN WILKINSON NP
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Gender | Female
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 7200 RHEA COUNTY HWY
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City | DAYTON
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State | TN
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Zip | 37321-6288
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Country | US
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Telephone | 423-570-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 WILSON DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-1544
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Country | US
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Telephone | 423-310-4026
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Fax |
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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 | 25767
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License Number State | TN
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