Provider Demographics
NPI:1063994523
Name:WILKENS, DEBORAH (FNP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WILKENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PHILIP BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8768
Mailing Address - Country:US
Mailing Address - Phone:770-962-3642
Mailing Address - Fax:770-962-3643
Practice Address - Street 1:455 PHILIP BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8768
Practice Address - Country:US
Practice Address - Phone:770-962-3642
Practice Address - Fax:770-962-3643
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220470163W00000X, 363LF0000X
GAF07180061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse