MEDICARE: MS. KATIE ELIZABETH WILKERSON PA

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	363A00000X	Physician Assistant	0010-12703	NC

General Provider Information

NPI Number	:	1801511175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE ELIZABETH WILKERSON PA

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6324 FAIRVIEW RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4278
Country	:	US
Telephone Number	:	704-384-0588
Fax Number	:	704-384-0580

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	01/19/2026

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