NPIMap

Individual provider Active NPI

Anne E Wilkerson, M.D.

  • Dermatopathology Physician
  • Georgetown, TX
National Provider Identifier
1245274331
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
P1714 Issued in TX
Practice address
3010 Williams Dr
Suite 210
Georgetown, TX 78628-2764
Phone
(512) 368-4944
Fax
(512) 869-0964
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X A92649 CA
Dermatopathology Physician 207ND0900X P1714 TX Primary

Addresses

Primary practice location

3010 Williams Dr
Suite 210
Georgetown, TX 78628-2764

Mailing address

101 Colorado St
Apt 2207
Austin, TX 78701-4103
Phone (805) 305-3863

Other identifiers 2

IdentifierTypeStateIssuer
00A926490MedicaidCA
GR0058760MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Central Coast Pathology Consultants, Inc Past Accepting new patients
Central Coast Pathology Consultants, Inc. Past Accepting new patients
Outreach Clinics Unlimited PLLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1245274331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 COLORADO ST",
            "address_2": "APT 2207",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787014103",
            "telephone_number": "805-305-3863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 WILLIAMS DR",
            "address_2": "SUITE 210",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786282764",
            "telephone_number": "512-368-4944",
            "fax_number": "512-869-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "ANNE",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "CA",
            "license": "A92649",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "P1714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A926490",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0058760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.