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NPI Code Detail

MEDICARE: KEITH WILKERSON PLPC

MEDICARE: KEITH WILKERSON PLPC
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1356876312
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH WILKERSON PLPC
Provider Business Mailing Address
First Line : 2525 YOUREE DR STE 110
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-3600
Country : US
Telephone Number : 318-742-3408
Fax Number :
Provider Business Practice Location Address
First Line : 525 ALEXANDER ST
Second Line :
City : JONESBORO
State : LA
Zip : 71251-2001
Country : US
Telephone Number : 318-259-4676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2017
Last Update Date : 04/27/2017

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Directions to “ KEITH WILKERSON PLPC” Practice Location

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