Provider Demographics
NPI:1700950334
Name:WILKINS, KATHERINE LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LOUISE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CURTISS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6713
Mailing Address - Fax:
Practice Address - Street 1:490 US HIGHWAY 80 E STE 200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9220
Practice Address - Country:US
Practice Address - Phone:972-329-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200112363A00000X
TXPA14124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1456373Medicaid
LA1456373Medicaid
LAQ75610Medicare UPIN