Healthcare Provider Details

I. General information

NPI: 1851223200
Provider Name (Legal Business Name): MRS. MAKENNA GRACE WILKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MED TECH PKWY STE 100
JOHNSON CITY TN
37604-4006
US

IV. Provider business mailing address

4 TEAGUE CT
JONESBOROUGH TN
37659-8601
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-1800
  • Fax: 423-794-1801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7279
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: