Individual provider Active NPI

Deborah Wilkens, FNP-C

  • Family Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1063994523
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-NP220470 Issued in GA
Practice address
455 Philip Blvd Ste 140
Lawrenceville, GA 30046-8768
Phone
(770) 962-3642
Fax
(770) 962-3643
NPI assigned
Aug 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN220470 GA
Family Nurse Practitioner 363LF0000X APRN-NP220470 GA Primary
Registered Nurse 163W00000X RN220470 GA
Family Nurse Practitioner 363LF0000X F07180061 GA

Addresses

Primary practice location

455 Philip Blvd Ste 140
Lawrenceville, GA 30046-8768

Mailing address

455 Philip Blvd Ste 140
Lawrenceville, GA 30046-8768
Phone (770) 962-3642

Other practice location 1

1200 Bald Ridge Marina Rd Ste 150
Cumming, GA 30041-8526
Phone (770) 962-3642

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181112002642 GA Practitioner - Nurse Practitioner 2365796257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Georgia Pain and Wellness CenterGroup PAC ID 8527200864, 53 clinicians

Practice addresses (Care Compare)

455 Philip Blvd
Suite 140
Lawrenceville, GA 30046-8768
Phone (770) 962-3642

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN220470GAMDRegistered Nurse
APRN-NP220470GAMDFamily Nurse Practitioner
F07180061GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Pain and Wellness Center CurrentSince Oct 1, 2018 Accepting new patients
Georgia Pain and Wellness Center CurrentSince Oct 1, 2018 Accepting new patients

Locations

1200 Bald Ridge Marina Rd
Ste 150
Cumming, GA 30041
Phone (770) 886-0003

455 Philip Blvd
Ste 140
Lawrenceville, GA 30046
Phone (787) 618-5889

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1063994523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD STE 140",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468768",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD STE 140",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468768",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Bald Ridge Marina Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Cumming",
            "state": "GA",
            "postal_code": "300418526",
            "country_code": "US",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKENS",
        "first_name": "DEBORAH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-31",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN220470",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP220470",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN220470",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F07180061",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.