MEDICARE: MS. CARRIE COLLEEN WILKIE

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	104100000X	Social Worker	39467	TX

General Provider Information

NPI Number	:	1386833887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE COLLEEN WILKIE

Provider Business Mailing Address
First Line	:	1917 KAREN SUE PL
Second Line	:	UNIT C
City	:	EL PASO
State	:	TX
Zip	:	79936-3985
Country	:	US
Telephone Number	:	915-373-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 KAREN SUE PL
Second Line	:	UNIT C
City	:	EL PASO
State	:	TX
Zip	:	79936-3985
Country	:	US
Telephone Number	:	915-373-3558
Fax Number	:

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

Provider Enumeration Date	:	10/20/2007
Last Update Date	:	10/20/2007

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