Provider Demographics
NPI:1689976508
Name:WILKES, SANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:WILKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:6885 W 151ST ST
Mailing Address - Street 2:STE 102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2507
Mailing Address - Country:US
Mailing Address - Phone:913-897-1100
Mailing Address - Fax:913-897-9696
Practice Address - Street 1:6885 W 151ST ST
Practice Address - Street 2:STE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2507
Practice Address - Country:US
Practice Address - Phone:913-897-1100
Practice Address - Fax:913-897-9696
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM996171100000X
MO2008033993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist