MEDICARE: MRS. JENNIFER KAYE WILKERSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3006410 GRP	KY
2	363L00000X	Nurse Practitioner	6410P	KY
3	363LF0000X	Family Nurse Practitioner	3006410	KY
4	363L00000X	Nurse Practitioner	3006410	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3006410	OTHER	KY	NEW APRN # 01-10-11
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	618423	OTHER	KY	WELLCARE

General Provider Information

NPI Number	:	1013231786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER KAYE WILKERSON APRN

Provider Business Mailing Address
First Line	:	1019 PADUCAH RD STE B
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-3616
Country	:	US
Telephone Number	:	270-804-7408
Fax Number	:	866-985-7514

Provider Business Practice Location Address
First Line	:	1019 PADUCAH RD STE B
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-3616
Country	:	US
Telephone Number	:	270-804-7408
Fax Number	:	866-985-7514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	07/01/2025

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