Organization
TRACI L WILKERSON AUD INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI L WILKERSON AUD (OWNER/PRACTITIONER)
(918) 682-1515
Entity
Organization
Contact information
Practice address
3312 W OKMULGEE ST, MUSKOGEE, OK 74401-5069
(918) 682-1515
(918) 682-1598
Mailing address
3312 W OKMULGEE ST, MUSKOGEE, OK 74401-5069
(918) 682-1515
(918) 682-1598
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
144
OK
231HA2500X
Assistive Technology Supplier Audiologist
144
OK
237600000X
Audiologist-Hearing Aid Fitter
144
OK
Other
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
Enumeration date
06/08/2007
Last updated
07/18/2015
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