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General NPI Number Information
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NPI Number | 1023212172
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Entity Type | Organization
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Legal Business Name | C. H. WILKINSON PHYSICIAN NETWORK
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 725 NORTH ASHLEY RIDGE SUITE 300
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 318-629-9630
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 WEST LOOP S SUITE 400B
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City | HOUSTON
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State | TX
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Zip | 77027-3005
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Country | US
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Telephone | 713-277-2200
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Fax |
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | DONNA J MIKULECKY
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Credential |
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Telephone | 713-277-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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