NPIMap

Individual provider Active NPI

Keionna Wilkerson, PA-C

  • Physician Assistant
  • Roswell, GA
National Provider Identifier
1851098891
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1180750 Issued in NC
Practice address
170 Ivywood LN
Roswell, GA 30076-1787
Phone
(323) 559-3205
NPI assigned
Feb 9, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 1180750 NC Primary

Addresses

Primary practice location

170 Ivywood LN
Roswell, GA 30076-1787

Mailing address

PO Box 896263
Charlotte, NC 28289-6263
Phone (323) 559-3205

Other practice location 1

210 Medical Pavilion Dr
Raeford, NC 28376-9111
Phone (910) 904-8000

Other practice location 2

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-6949

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803002492 NC Practitioner - Physician Assistant 6800257056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cumberland County Hospital System IncGroup PAC ID 1850204041, 581 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-4000

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028
  • Cape Fear Valley-Bladen County Hospital Hospital, Elizabethtown, NC, CCN 341315

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1180750NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc CurrentSince Jun 19, 2023 Accepting new patients
Cumberland County Hospital System Inc Past Accepting new patients

Locations

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

210 Medical Pavilion Dr
Raeford, NC 28376
Phone (910) 904-8000

Interoperability endpoints

  • Direct secure messaging: kwilkerson113968@capefearvalley.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1851098891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896263",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896263",
            "telephone_number": "323-559-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 IVYWOOD LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761787",
            "telephone_number": "323-559-3205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 Medical Pavilion Dr",
            "address_purpose": "LOCATION",
            "city": "Raeford",
            "state": "NC",
            "postal_code": "283769111",
            "country_code": "US",
            "telephone_number": "910-904-8000",
            "fax_number": "910-904-8445",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1638 Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043424",
            "country_code": "US",
            "telephone_number": "910-615-6949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "KEIONNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-09",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "1180750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.