Active NPI
Phillip Curtis Wilkerson, ATC
- Athletic Trainer
- Norfolk, VA
National Provider Identifier
1447760376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126002836
- Practice address
- 4251 Powhatan Ave
Norfolk, VA 23508-2225 - Phone
- (757) 683-4255
- NPI assigned
- Oct 5, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126002836 | VA | Primary |
Addresses
Primary practice location
4251 Powhatan Ave
Norfolk, VA 23508-2225
Mailing address
413 Lake Havasu Dr
Virginia Beach, VA 23454-3976
Phone (757) 381-3280
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0126002836 | Other | VA | STATE LICENSURE |
| 096.002700 | Other | IL | STATE LICENSURE |
| 408 | Other | AR | STATE LICENSURE |
| 003741 | Other | OH | STATE LICENSURE |
| 120402189 | Other | BOC CERTIFICATION |
Other names 1
- N/a N/a N/a
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126002836 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1447760376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 LAKE HAVASU DR",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234543976",
"telephone_number": "757-381-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4251 POWHATAN AVE",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235082225",
"telephone_number": "757-683-4255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKERSON",
"first_name": "PHILLIP",
"middle_name": "CURTIS",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-05",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126002836",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE",
"identifier": "0126002836",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE",
"identifier": "096.002700",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE",
"identifier": "408",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE",
"identifier": "003741",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC CERTIFICATION",
"identifier": "120402189",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "N/A",
"last_name": "N/A",
"middle_name": "N/A",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.