Healthcare Provider Details

I. General information

NPI: 1396063111
Provider Name (Legal Business Name): DEBBIE ANN WILKERSON BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 N CLASSEN BLVD STE 325
OKLAHOMA CITY OK
73106-5462
US

IV. Provider business mailing address

1301 NW 85TH ST
OKLAHOMA CITY OK
73114-1623
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-4574
  • Fax:
Mailing address:
  • Phone: 405-921-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number261QMO801X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: