Provider Demographics
NPI:1396045506
Name:WILKINS, DUSTY R (MSN, FNP)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:R
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:DUSTY
Other - Middle Name:R
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:27815 GEORGE OBRIEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1453
Mailing Address - Country:US
Mailing Address - Phone:210-846-4979
Mailing Address - Fax:866-270-6732
Practice Address - Street 1:2929 MOSSROCK STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5141
Practice Address - Country:US
Practice Address - Phone:210-846-4979
Practice Address - Fax:866-270-6732
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119444363LA2100X, 363LC1500X, 363LG0600X, 363LP2300X, 363L00000X
TX680616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care