Keilyn Wilkerson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA32379 Issued in FL

Practice address

395 Village Drive
Kissimmee, FL 34759

Phone

(407) 914-9168

Fax

(407) 337-8005

NPI assigned

Oct 17, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• C3 Wellness, LLC

  • Multi-Specialty Clinic/Center
  • Kissimmee, FL
  • NPI 1811490287
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1811613367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 EAGLE CANYON DRIVE SOUTH",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34746",
            "telephone_number": "919-606-6423",
            "fax_number": "407-337-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 VILLAGE DRIVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34759",
            "telephone_number": "407-914-9168",
            "fax_number": "407-337-8005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1060 Cypress Parkway Suite 104",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "34759",
            "country_code": "US",
            "telephone_number": "407-914-9168 x1",
            "fax_number": "407-337-8005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "KEILYN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA32379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112243500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Wiercinski, APRN
• Gabrielle Nicole Wiggins, BCBA
• Carolyn Wigmore, RBT
• Luana Wilendez, RN
• Florence Youngblood Wilkerson
• Lasherrie B Wilkerson
• Veronica Wilkins, PTA
• Angela Diana Wilkinson Christie, RMHCI
• Cailyn Rae Will, BEHAVIOR TECHNICIAN
• Jolem Will, APRN

• Physical Therapy Assistant in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.