Basic Information
| Provider Information | |||||||||
| NPI: | 1558972117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILKERSON | ||||||||
| FirstName: | AMANYE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSW,RSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2225 COLLEGE DR APT 78 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708081871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047225280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 415 COURT ST | ||||||||
| Address2: | |||||||||
| City: | PORT ALLEN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707672747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252459070 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2020 | ||||||||
| LastUpdateDate: | 08/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | LA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.