MEDICARE: LARRY WILKES FNP PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277000628	IL
2	363LF0000X	Family Nurse Practitioner	277000628	IL

General Provider Information

NPI Number	:	1942623525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY WILKES FNP PMHNP

Provider Business Mailing Address
First Line	:	8556 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4709
Country	:	US
Telephone Number	:	773-569-7470
Fax Number	:

Provider Business Practice Location Address
First Line	:	8556 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4709
Country	:	US
Telephone Number	:	773-569-7470
Fax Number	:

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

Provider Enumeration Date	:	02/01/2014
Last Update Date	:	06/15/2026

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