MEDICARE: EVE JENNIFER KERMAN WILSON PMHNP-BC

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	163W00000X	Registered Nurse	RN2316939	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0038941	OH

General Provider Information

NPI Number	:	1851819478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE JENNIFER KERMAN WILSON PMHNP-BC

Provider Business Mailing Address
First Line	:	2717 ROCKLYN RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2114
Country	:	US
Telephone Number	:	216-470-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 ROCKLYN RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2114
Country	:	US
Telephone Number	:	216-470-7887
Fax Number	:	216-307-1716

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

Provider Enumeration Date	:	09/04/2017
Last Update Date	:	12/02/2025

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