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General NPI Number Information
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NPI Number | 1962882449
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Entity Type | Individual
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Provider Name | KELLY A. WILKINSON CNM
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Gender | Female
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 2510 COMMONS BLVD STE 270
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City | BEAVERCREEK
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State | OH
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Zip | 45431-3834
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Country | US
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Telephone | 937-431-0200
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Fax | 937-431-0488
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Provider Business Mailing Address
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Address Line | 3535 PENTAGON BLVD STE 220
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City | BEAVERCREEK
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State | OH
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Zip | 45431-1705
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Country | US
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Telephone | 937-429-7350
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Fax | 937-431-2623
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | COA.16865-NM
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License Number State | OH
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