Provider Demographics
NPI:1992007439
Name:WILKINS, TREVER LYNN (DO)
Entity Type:Individual
Prefix:
First Name:TREVER
Middle Name:LYNN
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3619
Mailing Address - Country:US
Mailing Address - Phone:928-692-3456
Mailing Address - Fax:
Practice Address - Street 1:290 S ALMA SCHOOL RD STE 15
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7633
Practice Address - Country:US
Practice Address - Phone:480-660-8817
Practice Address - Fax:949-577-4124
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005759207PE0004X, 207PS0010X
AZR1798390200000X
NMA-1777-13207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program