Provider Demographics
NPI:1407245822
Name:WILSON, TIKESHIA
Entity Type:Individual
Prefix:MRS
First Name:TIKESHIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIKESHIA
Other - Middle Name:
Other - Last Name:DICKERSON-ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9613 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7356
Mailing Address - Country:US
Mailing Address - Phone:405-283-0165
Mailing Address - Fax:
Practice Address - Street 1:9613 SQUIRE LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7356
Practice Address - Country:US
Practice Address - Phone:405-283-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator