Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | E6232 | AR |
NPI | 1255517066 |
---|---|
Provider Name | Joshua R Wilkinson |
First Address | Fort Smith, AR 72916-4278 |
Second Address | Fort Smith, AR 72916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2008 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100047310 | (05) | KY |