Provider Demographics
NPI:1245748839
Name:WILKERSON, ANNIE LAURYL
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAURYL
Last Name:WILKERSON
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 1:375 CLARK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:AL
Mailing Address - Zip Code:35760-9345
Mailing Address - Country:US
Mailing Address - Phone:256-714-4581
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN STREET
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811
Practice Address - Country:US
Practice Address - Phone:256-714-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer