Deletra Michelle Wilke, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3239 Issued in TN

Practice address

3959 Highway 411
Madisonville, TN 37354-4417

Phone

(423) 442-2121

Fax

(423) 545-9556

NPI assigned

Mar 10, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Madisonville Primary Care Group PLLCGroup PAC ID 6507037645, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Madisonville Primary Care Group PLLC

  • Rural Health Clinic/Center
  • Madisonville, TN
  • NPI 1861780496

  Medical

  Medicare reassignment Care Compare group NPD
• Madisonville Primary Care Group PLLC

  • Rural Health Clinic/Center
  • Etowah, TN
  • NPI 1780304238
  NPD (past)

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

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1841731817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377630808",
            "telephone_number": "865-224-7172",
            "fax_number": "865-224-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3959 HIGHWAY 411",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "373544417",
            "telephone_number": "423-442-2121",
            "fax_number": "423-545-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKE",
        "first_name": "DELETRA",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-10",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3239",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "3239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Heather Watson, MA CCC-SLP
• Tasha Watson, LCSW
• Lauren Ann White
• Sara Wiatrek, DC
• Wil-Sav Clinical Services PLLC
• Cana Williams
• Jason K Williams
• Wilson Drugs Inc
• Cameron Lee Wolfe, DDS
• Women'S Wellness and Maternity Center

• Medical Physician Assistant in Madisonville, TN
• Providers in Madisonville, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.