Healthcare Provider Details

I. General information

NPI: 1568389757
Provider Name (Legal Business Name): TERRIE WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SW 148TH ST
OKLAHOMA CITY OK
73170-7289
US

IV. Provider business mailing address

16 SW 148TH ST
OKLAHOMA CITY OK
73170-7289
US

V. Phone/Fax

Practice location:
  • Phone: 305-903-0602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: