1780981498 NPI number — TIM WILKIN D.O., P.A.

Table of content: STEPHANIE CHRISTINE CALEY FNP (NPI 1538987698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780981498 NPI number — TIM WILKIN D.O., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIM WILKIN D.O., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780981498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8608 DOLLARWAY RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
WHITE HALL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71602-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-247-8900
Provider Business Mailing Address Fax Number:
870-247-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8608 DOLLARWAY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WHITE HALL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71602-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-247-8900
Provider Business Practice Location Address Fax Number:
870-247-8903
Provider Enumeration Date:
02/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WILKIN
Authorized Official First Name:
TIM
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-247-8900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5K460 . This is a "BLUE CROSS BLUE SHIELD/MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131533003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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