Provider Demographics
NPI:1275706251
Name:WILKS, KATE JENNINGS (MD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:JENNINGS
Last Name:WILKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 GEARY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6842
Mailing Address - Country:US
Mailing Address - Phone:541-812-5570
Mailing Address - Fax:541-812-5699
Practice Address - Street 1:1700 GEARY ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6842
Practice Address - Country:US
Practice Address - Phone:541-812-5570
Practice Address - Fax:541-812-5699
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23881207Q00000X
OR159513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine