Provider Demographics
NPI:1902896947
Name:WILKERSON, BILLIE F (MD)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:F
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S MEDICAL ARTS CT STE D
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3372
Mailing Address - Country:US
Mailing Address - Phone:307-686-0308
Mailing Address - Fax:307-686-7420
Practice Address - Street 1:407 S MEDICAL ARTS CT STE D
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-686-0308
Practice Address - Fax:307-686-7420
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6685A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117468100Medicaid
WY117468100Medicaid
WYW26857Medicare PIN