Provider Demographics
NPI:1073526315
Name:WILKINSON, SARA KENNY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KENNY
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3500
Mailing Address - Country:US
Mailing Address - Phone:901-685-8245
Mailing Address - Fax:901-685-8248
Practice Address - Street 1:5220 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3500
Practice Address - Country:US
Practice Address - Phone:901-685-8245
Practice Address - Fax:901-685-8248
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN68116207Q00000X
TNAPN6001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4093897OtherBLUE CROSS BLUE SHIELD
TN4093897OtherBLUE CROSS BLUE SHIELD
584157Medicare UPIN
TN3903433Medicare ID - Type Unspecified