Provider Demographics
NPI:1982617239
Name:WILKERSON, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2016
Mailing Address - Country:US
Mailing Address - Phone:214-823-4800
Mailing Address - Fax:214-823-4801
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2016
Practice Address - Country:US
Practice Address - Phone:214-823-4800
Practice Address - Fax:214-823-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046194901Medicaid
TX84426XOtherBCBS
TX046194901Medicaid
TX110186865Medicare PIN
TX87X765Medicare PIN