Provider Demographics
NPI:1609063437
Name:WILKERSON, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:WILKERSON
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:PO BOX 881
Mailing Address - Street 2:171 DOTY ROAD
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-0881
Mailing Address - Country:US
Mailing Address - Phone:318-757-8594
Mailing Address - Fax:318-757-6855
Practice Address - Street 1:171 DOTY RD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-4053
Practice Address - Country:US
Practice Address - Phone:318-757-8594
Practice Address - Fax:318-757-6855
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1459071343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)