Provider Demographics
NPI:1023054244
Name:WILKES, JOE NORMAN II (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:NORMAN
Last Name:WILKES
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BRANDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594
Mailing Address - Country:US
Mailing Address - Phone:205-487-4843
Mailing Address - Fax:
Practice Address - Street 1:NORTHWEST MEDICAL CENTER
Practice Address - Street 2:1530 US HIGHWAY 43
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-7000
Practice Address - Fax:205-487-7645
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-094772367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-22617OtherBCBS AL PIN
AL515-22751OtherBCBS AL -LAMAR SURG CTR
AL515-22617OtherBCBS AL PIN