Provider Demographics
NPI:1760639959
Name:WILKINS, WALTER DAVID (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DAVID
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6834
Mailing Address - Country:US
Mailing Address - Phone:956-968-0326
Mailing Address - Fax:
Practice Address - Street 1:1220 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6420
Practice Address - Country:US
Practice Address - Phone:956-973-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant