Active NPI
Amru Oketa Nicole Wilks, RPA-C
- Physician Assistant
- Jamaica, NY
National Provider Identifier
1669771267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 014713
- Practice address
- 17742 136TH Ave
Jamaica, NY 11434-4014 - Phone
- (718) 316-3972
- NPI assigned
- Mar 22, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 014713 | NY | Primary |
Addresses
Primary practice location
17742 136TH Ave
Jamaica, NY 11434-4014
Mailing address
17742 136TH Ave
Jamaica, NY 11434-4014
Phone (718) 316-3972
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1090221 | Other | NY | NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA) |
| 014713 | Other | NY | NEW YORK STATE PHYSICIAN ASSISTANT LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014713 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302220800000",
"number": "1669771267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17742 136TH AVE",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114344014",
"telephone_number": "718-316-3972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17742 136TH AVE",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114344014",
"telephone_number": "718-316-3972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKS",
"first_name": "AMRU",
"middle_name": "OKETA NICOLE",
"name_prefix": "Miss",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-22",
"last_updated": "2011-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "014713",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)",
"identifier": "1090221",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE PHYSICIAN ASSISTANT LICENSE",
"identifier": "014713",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.