Provider Demographics
NPI:1689080269
Name:WILKERSON, GRETCHEN RENEE (NP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RENEE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4861
Mailing Address - Country:US
Mailing Address - Phone:337-460-7688
Mailing Address - Fax:337-460-7691
Practice Address - Street 1:301 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4861
Practice Address - Country:US
Practice Address - Phone:337-460-7688
Practice Address - Fax:337-460-7691
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily