Provider Demographics
NPI:1902161235
Name:WILKES, SHELBY CHENTEL
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:CHENTEL
Last Name:WILKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 NUCKOLLS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1532
Mailing Address - Country:US
Mailing Address - Phone:731-541-8344
Mailing Address - Fax:731-541-8970
Practice Address - Street 1:622 NUCKOLLS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1532
Practice Address - Country:US
Practice Address - Phone:731-541-8344
Practice Address - Fax:731-541-8970
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator