Provider Demographics
NPI:1881766970
Name:WILKINSON, VICTORIA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:GRACE
Other - Last Name:CAVENDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 S COULTER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1765
Mailing Address - Country:US
Mailing Address - Phone:806-367-9855
Mailing Address - Fax:806-367-9865
Practice Address - Street 1:1301 S COULTER ST STE 201
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1765
Practice Address - Country:US
Practice Address - Phone:806-367-9855
Practice Address - Fax:806-367-9865
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05031363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1075350OtherP.A.-C CERTIFICATE NUMBER