Provider Demographics
NPI:1245330844
Name:GILBERT-PARKER, JACQUELINE WILKINSON (PA)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:WILKINSON
Last Name:GILBERT-PARKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0339
Mailing Address - Country:US
Mailing Address - Phone:530-926-5261
Mailing Address - Fax:530-926-1077
Practice Address - Street 1:822 PINE STREET
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067
Practice Address - Country:US
Practice Address - Phone:530-926-5261
Practice Address - Fax:530-926-1077
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant