Individual
NATALIE RUTH WILBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 SUNSET TRL, JELLICO, TN 37762-2343
(423) 784-5771
(423) 784-6185
Mailing address
107 S MAIN ST, P.O. BOX 540, JELLICO, TN 37762-2154
(423) 784-8492
(423) 784-8358
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1558
KY
363A00000X
Physician Assistant
Primary
1798
TN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518501
—
TN
01
—
1558
STATE LICENSE
KY
01
—
1798
STATE LICENSE
TN
05
—
7100119880
—
KY
Enumeration date
11/23/2009
Last updated
03/07/2023
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