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NPI Code Detail

MEDICARE: AMANDA WILKS PA-C

MEDICARE:   AMANDA  WILKS  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianPA1117TN
2363A00000XPhysician AssistantPA1117TN

General Provider Information

NPI Number : 1265486484
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILKS PA-C
Provider Business Mailing Address
First Line : 939 EMERALD AVE
Second Line : SUITE 705
City : KNOXVILLE
State : TN
Zip : 37917-4502
Country : US
Telephone Number : 865-524-2547
Fax Number : 865-524-0224
Provider Business Practice Location Address
First Line : 939 EMERALD AVE
Second Line : SUITE 705
City : KNOXVILLE
State : TN
Zip : 37917-4502
Country : US
Telephone Number : 865-524-2547
Fax Number : 865-524-0224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 02/26/2008

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Directions to “ AMANDA WILKS PA-C” Practice Location

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