Provider Demographics
NPI:1316376023
Name:WILKES, COURTNEY (DOT R/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:DOT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 CALAHONDA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-4558
Mailing Address - Country:US
Mailing Address - Phone:702-372-5289
Mailing Address - Fax:
Practice Address - Street 1:543 CALAHONDA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-4558
Practice Address - Country:US
Practice Address - Phone:702-372-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11-0122174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist