Provider Demographics
NPI:1558049908
Name:WILKS, MADELYN KAYE
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:KAYE
Last Name:WILKS
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 1:10101 PARK ROWE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1685
Mailing Address - Country:US
Mailing Address - Phone:225-769-2200
Mailing Address - Fax:833-756-2680
Practice Address - Street 1:10101 PARK ROWE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1685
Practice Address - Country:US
Practice Address - Phone:225-769-2200
Practice Address - Fax:833-756-2680
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA337651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant