Healthcare Provider Details

I. General information

NPI: 1336342161
Provider Name (Legal Business Name): TRACI LEE WILKERSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/11/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

IV. Provider business mailing address

3312 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-1515
  • Fax: 918-682-1598
Mailing address:
  • Phone: 918-682-1515
  • Fax: 918-682-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number144
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number144
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number144
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: