Provider Demographics
NPI:1861535320
Name:GILCHRIST-WICKLIFFE, DEEDRIA
Entity type:Individual
Prefix:MRS
First Name:DEEDRIA
Middle Name:
Last Name:GILCHRIST-WICKLIFFE
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 1:900 PRIVATE ROAD 25165
Mailing Address - Street 2:APT 2
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501
Mailing Address - Country:US
Mailing Address - Phone:313-207-4334
Mailing Address - Fax:248-546-1640
Practice Address - Street 1:900 PRIVATE ROAD 25165
Practice Address - Street 2:APT 2
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:313-413-3122
Practice Address - Fax:248-546-1640
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician