Provider Demographics
NPI:1902937808
Name:WILKERSON, ALICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S COOPER ST
Mailing Address - Street 2:STE 111
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5933
Mailing Address - Country:US
Mailing Address - Phone:817-468-9999
Mailing Address - Fax:817-468-9733
Practice Address - Street 1:5201 S COOPER ST
Practice Address - Street 2:STE 111
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5933
Practice Address - Country:US
Practice Address - Phone:817-468-9999
Practice Address - Fax:817-468-9733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine