Healthcare Provider Details

I. General information

NPI: 1225188121
Provider Name (Legal Business Name): TIMOTHEE TREVEVANT WILKIN D.O., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DOLLARWAY RD
WHITE HALL AR
71602-3094
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-7088
  • Fax: 870-247-7089
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1340
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: