Healthcare Provider Details

I. General information

NPI: 1376262659
Provider Name (Legal Business Name): KATHERINE WILKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 WALKERS WAY STE 101
SAN ANTONIO TX
78216-7752
US

IV. Provider business mailing address

690 CLUBS DR
BOERNE TX
78006-6191
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18443
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: