Healthcare Provider Details

I. General information

NPI: 1831618396
Provider Name (Legal Business Name): ANTHONY GLEN WILKERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 S MCCOLL RD
EDINBURG TX
78539-9183
US

IV. Provider business mailing address

5501 S MCCOLL RD
EDINBURG TX
78539-5503
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-0529
  • Fax:
Mailing address:
  • Phone: 956-605-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: