Healthcare Provider Details

I. General information

NPI: 1124482146
Provider Name (Legal Business Name): WILKES PHYSICIAN NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 W PARK DR
NORTH WILKESBORO NC
28659-3563
US

IV. Provider business mailing address

1914 W PARK DR
NORTH WILKESBORO NC
28659-3563
US

V. Phone/Fax

Practice location:
  • Phone: 336-903-7710
  • Fax: 336-903-7711
Mailing address:
  • Phone: 336-903-7710
  • Fax: 336-903-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRIEDA M LOWDER
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 704-403-2276