Provider Demographics
NPI:1497876981
Name:WILKINSON, LAKECIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAKECIA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2261
Mailing Address - Country:US
Mailing Address - Phone:480-980-0801
Mailing Address - Fax:
Practice Address - Street 1:575 E 100 S
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3102
Practice Address - Country:US
Practice Address - Phone:435-637-2358
Practice Address - Fax:435-637-9141
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295277-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant