# TRACI L WILKERSON AUD INC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861695611
- **Authorized official:** MRS. TRACI L WILKERSON AUD (OWNER/PRACTITIONER)
- **Authorized official phone:** (918) 682-1515

## Contact information

- **Practice address:** 3312 W OKMULGEE ST, MUSKOGEE, OK 74401-5069
- **Practice address phone:** (918) 682-1515
- **Practice address fax:** (918) 682-1598
- **Mailing address:** 3312 W OKMULGEE ST, MUSKOGEE, OK 74401-5069
- **Mailing address phone:** (918) 682-1515
- **Mailing address fax:** (918) 682-1598

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 144 | OK | Yes |
| 231HA2500X | Assistive Technology Supplier Audiologist | 144 | OK | — |
| 237600000X | Audiologist-Hearing Aid Fitter | 144 | OK | — |

## Other

- **Enumeration date:** 06/08/2007
- **Last updated:** 07/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 100676030C | DHS - DDSD | OK |
| 01 | — | 100676030D | DHS - DDSD | OK |
| 01 | — | 100676030E | DHS - DDSD | OK |
| 01 | — | 100676030F | DHS - DDSD | OK |
| 01 | — | 101410900 | DEPARTMENT OF LABOR | OK |
| 01 | — | DC 0957 | MEDICARE RAILROAD | OK |