Healthcare Provider Details

I. General information

NPI: 1619361078
Provider Name (Legal Business Name): DENITA WILKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13230 MANCHESTER RD
DES PERES MO
63131-1706
US

IV. Provider business mailing address

5132 N ELSTON AVE
CHICAGO IL
60630-2429
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-2886
  • Fax:
Mailing address:
  • Phone: 847-235-6130
  • Fax: 847-235-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020002138
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: