Provider Demographics
NPI:1487843371
Name:WILKES, COURTNEY NICHOLE
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:NICHOLE
Last Name:WILKES
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 1:1439 WESTON WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5756
Mailing Address - Country:US
Mailing Address - Phone:407-758-0144
Mailing Address - Fax:
Practice Address - Street 1:1439 WESTON WOODS BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5756
Practice Address - Country:US
Practice Address - Phone:407-758-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist