Provider Demographics
NPI:1811947583
Name:WILKENS, LAURA DIANNE (MSN- CRNA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DIANNE
Last Name:WILKENS
Suffix:
Gender:F
Credentials:MSN- CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:18797 ALBERTA STREET
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2127
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1108135 ARNP4723A367500000X
TN11198367500000X
KY4723A367500000X
TN87629367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000001218303OtherCHA HEALTH
TNP00695348OtherRAILROAD MEDICARE PIN
KY000000382181OtherANTHEM BCBS KY
KY000000382181OtherUNICARE
KY74002270Medicaid
KYP00309974OtherRAILROAD MEDICARE PIN
KY000000382181OtherKENTUCKY ACCESS
TN3630866Medicaid
TN4126702OtherBLUE CROSS/BLUE SHIELD
KY000000382181OtherBLUE CROSS/BLUE SHIELD
TNP00695348OtherRAILROAD MEDICARE PIN
KY74002270Medicaid
KY0000001218303OtherCHA HEALTH