Provider Demographics
NPI:1366720179
Name:WILBANKS, ALLISON CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:CHRISTINE
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CHRISTINE
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 EAST BROAD STREET
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6414
Mailing Address - Country:US
Mailing Address - Phone:817-539-0959
Mailing Address - Fax:817-539-0480
Practice Address - Street 1:723 NORTH FIELDER ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4662
Practice Address - Country:US
Practice Address - Phone:817-261-1122
Practice Address - Fax:817-261-1123
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant