Provider Demographics
NPI:1225124126
Name:WILKINSON, MARY CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 BELLAIRE DR S STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5855
Mailing Address - Country:US
Mailing Address - Phone:817-926-9642
Mailing Address - Fax:817-926-1865
Practice Address - Street 1:5521 BELLAIRE DR S STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5855
Practice Address - Country:US
Practice Address - Phone:817-926-9642
Practice Address - Fax:817-926-1865
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMW4878229363LF0000X
CO3532111N00000X
KS4246111N00000X
TX4136111N00000X
NC5010792363LF0000X
KS53-79021-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-79021-122OtherLICENSE