Provider Demographics
NPI:1104790724
Name:WILKES, KENNEDY S (APRN)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:S
Last Name:WILKES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0058
Mailing Address - Country:US
Mailing Address - Phone:731-438-3090
Mailing Address - Fax:731-256-0757
Practice Address - Street 1:60 BRAZELTON ST UNIT 6
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3080
Practice Address - Country:US
Practice Address - Phone:731-438-3090
Practice Address - Fax:731-256-0757
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner