Provider Demographics
NPI:1710426176
Name:WILKINSON, SAMANTHA R (NP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:R
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:23435 WOODBURN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9740
Mailing Address - Country:US
Mailing Address - Phone:260-414-1855
Mailing Address - Fax:
Practice Address - Street 1:2720 DUPONT COMMERCE CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2394
Practice Address - Country:US
Practice Address - Phone:260-484-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006896B363LF0000X
IN71006896A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily