Provider Demographics
NPI:1205290376
Name:WILKINS, SERENA DEANN (MD)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:DEANN
Last Name:WILKINS
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 1:3331 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2115
Mailing Address - Country:US
Mailing Address - Phone:318-868-6555
Mailing Address - Fax:318-868-6009
Practice Address - Street 1:3331 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-868-6555
Practice Address - Fax:318-868-6009
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2417401Medicaid