1720281959 NPI number — MRS. CAROLYN JANET WILKINS LCDC

Table of content: MRS. CAROLYN JANET WILKINS LCDC (NPI 1720281959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720281959 NPI number — MRS. CAROLYN JANET WILKINS LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINS
Provider First Name:
CAROLYN
Provider Middle Name:
JANET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKINS
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
JANET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCDC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720281959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1312 VINEYARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-699-9808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1312 VINEYARD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002-0957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-699-9808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  3069 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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