Provider Demographics
NPI:1598441628
Name:WILKES, REBECCA (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-0249
Mailing Address - Country:US
Mailing Address - Phone:318-785-0102
Mailing Address - Fax:318-785-0103
Practice Address - Street 1:10542 HWY 1
Practice Address - Street 2:
Practice Address - City:MOREAVILLE
Practice Address - State:LA
Practice Address - Zip Code:71355
Practice Address - Country:US
Practice Address - Phone:318-785-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily