Individual provider Active NPI

Kalli Taylor-Suzanne Wilks, NP

  • Primary Care Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1083308464
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APRN11026544 Issued in FL
Practice address
1545 Airport Blvd Ste 2000
Pensacola, FL 32504-8615
Phone
(850) 416-6933
Fax
(850) 416-6934
NPI assigned
Jun 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X APRN11026544 FL Primary

Addresses

Primary practice location

1545 Airport Blvd Ste 2000
Pensacola, FL 32504-8615

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6063

Other practice location 1

5147 N 9th Ave
Pensacola, FL 32504-8771
Phone (850) 416-7196

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230724004085 FL Practitioner - Nurse Practitioner 1052771938 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Heart Health System IncGroup PAC ID 3779491386, 373 clinicians

Practice addresses (Care Compare)

1545 Airport Blvd
Suite 2000
Pensacola, FL 32504-8615
Phone (850) 416-6933

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11026544FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health System Inc CurrentSince Jul 9, 2023 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients
Sacred Heart Health System, Inc. CurrentSince Jul 9, 2023 Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

5147 N 9th Ave
Pensacola, FL 32504
Phone (850) 416-2965

1545 Airport Blvd
Ste 2000
Pensacola, FL 32504
Phone (850) 416-6933

1545 Airport Blvd
#2000
Pensacola, FL 32504
Phone (850) 416-6933

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1083308464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6063",
            "fax_number": "904-539-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 AIRPORT BLVD STE 2000",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048615",
            "telephone_number": "850-416-6933",
            "fax_number": "850-416-6934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5147 N 9th Ave",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325048771",
            "country_code": "US",
            "telephone_number": "850-416-7196",
            "fax_number": "850-416-6934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKS",
        "first_name": "KALLI",
        "middle_name": "TAYLOR-SUZANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11026544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.