Provider Demographics
NPI:1609481795
Name:WILSON, SHAKIRA
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:WILSON
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 1:1255 N POST OAK RD APT 2202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7336
Mailing Address - Country:US
Mailing Address - Phone:832-836-1748
Mailing Address - Fax:
Practice Address - Street 1:3611 ENNIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4407
Practice Address - Country:US
Practice Address - Phone:832-393-4062
Practice Address - Fax:832-393-4068
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9762172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker