Provider Demographics
NPI:1649256330
Name:WILKINS, KENNETH LEON II (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEON
Last Name:WILKINS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4561
Mailing Address - Country:US
Mailing Address - Phone:615-794-8700
Mailing Address - Fax:
Practice Address - Street 1:782 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4561
Practice Address - Country:US
Practice Address - Phone:615-794-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005036408207Q00000X
TN48991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine