Healthcare Provider Details

I. General information

NPI: 1407765969
Provider Name (Legal Business Name): LYNDRA WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 COURT ST
MUSKOGEE OK
74401-6303
US

IV. Provider business mailing address

13115 E 31ST ST APT L
TULSA OK
74134-8012
US

V. Phone/Fax

Practice location:
  • Phone: 918-310-0000
  • Fax:
Mailing address:
  • Phone: 918-360-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: