Provider Demographics
NPI:1619277712
Name:WILKERSON, ANJALI K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:K
Last Name:WILKERSON
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 1:6651 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0602
Mailing Address - Country:US
Mailing Address - Phone:916-965-1111
Mailing Address - Fax:916-965-5143
Practice Address - Street 1:576 N. SUNRISE AVE, STE. 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-773-3444
Practice Address - Fax:916-773-3474
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21083363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical