Provider Demographics
NPI:1811623440
Name:WILBANKS, LYDIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1455 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6727
Mailing Address - Country:US
Mailing Address - Phone:901-726-6655
Mailing Address - Fax:
Practice Address - Street 1:795 RIDGE LAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9475
Practice Address - Country:US
Practice Address - Phone:726-665-5901
Practice Address - Fax:901-726-9056
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-12-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical