Provider Demographics
NPI:1659759579
Name:WILKINS, INGRID DANIELLE
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:DANIELLE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:INGRID
Other - Middle Name:DANIELLE
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1719 MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4009
Mailing Address - Country:US
Mailing Address - Phone:501-663-2199
Mailing Address - Fax:
Practice Address - Street 1:1719 MERRILL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4009
Practice Address - Country:US
Practice Address - Phone:501-663-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator