Healthcare Provider Details

I. General information

NPI: 1083089031
Provider Name (Legal Business Name): LEKEITHIA WILKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 ARROWHEAD DR
FAIRFAX VA
22030
US

IV. Provider business mailing address

11331 EDENDERRY DR
FAIRFAX VA
22030-5406
US

V. Phone/Fax

Practice location:
  • Phone: 571-432-2600
  • Fax:
Mailing address:
  • Phone: 706-267-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: