Provider Demographics
NPI:1710923438
Name:STOKES, WYVITRA KNOX (PA-C)
Entity Type:Individual
Prefix:
First Name:WYVITRA
Middle Name:KNOX
Last Name:STOKES
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 1:642 ULUKAHIKI ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4439
Mailing Address - Country:US
Mailing Address - Phone:808-230-8500
Mailing Address - Fax:808-230-8501
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:SUITE 209
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4439
Practice Address - Country:US
Practice Address - Phone:808-230-8500
Practice Address - Fax:808-230-8501
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57593801Medicaid
HI101031Medicare ID - Type Unspecified
HIQ56904Medicare UPIN