# THAD W WILKEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1174513188
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA280 | ID | Yes |

## Other

- **Enumeration date:** 10/21/2005
- **Last updated:** 01/25/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010138646 | BLUE SHIELD | ID |
| 01 | — | 000010139188 | BLUE SHIELD | ID |
| 01 | — | 000010147742 | BLUE SHIELD | ID |
| 05 | — | 806348800 | — | ID |
| 01 | — | 970026445 | RAILROAD MEDICARE | ID |
| 01 | — | PACB4 | BLUE CROSS | ID |
| 01 | — | PACC2 | BLUE CROSS | ID |
| 01 | — | PANX1 | BLUE CROSS | ID |