Provider Demographics
NPI:1194320663
Name:WILKEN, BRITTNI LYNN
Entity type:Individual
Prefix:
First Name:BRITTNI
Middle Name:LYNN
Last Name:WILKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2241
Mailing Address - Country:US
Mailing Address - Phone:660-473-2513
Mailing Address - Fax:
Practice Address - Street 1:910 THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2241
Practice Address - Country:US
Practice Address - Phone:660-473-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020038502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist