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Individual
MRS. COURTNEY LEE BENNETT WILKE
Active
Individual
MRS. COURTNEY LEE BENNETT WILKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12767
GA
363A00000X
Physician Assistant
PA9105489
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003175470B
—
GA
01
—
12767
GEORGIA COMPOSITE MEDICAL BOARD
GA
Enumeration date
07/22/2010
Last updated
03/03/2025
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