Provider Demographics
NPI:1588878839
Name:WILKS, KATI LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATI
Middle Name:LYNN
Last Name:WILKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BELLE TRACE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3570
Mailing Address - Country:US
Mailing Address - Phone:731-668-0333
Mailing Address - Fax:
Practice Address - Street 1:670 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3934
Practice Address - Country:US
Practice Address - Phone:731-425-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122491835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric