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Individual

THAD W WILKEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
2101 N WHITLEY DR, FRUITLAND, ID 83619-2132
(208) 452-5999
(208) 452-4499
Mailing address
2101 N WHITLEY DR, FRUITLAND, ID 83619-2132
(208) 452-5999
(208) 452-4499

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA280
ID

Other

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
Enumeration date
10/21/2005
Last updated
01/25/2021
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