Provider Demographics
NPI:1750611299
Name:WILKIE, TYA BETH (BS, MS)
Entity type:Individual
Prefix:
First Name:TYA
Middle Name:BETH
Last Name:WILKIE
Suffix:
Gender:F
Credentials:BS, MS
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Mailing Address - Street 1:5517 50TH ST APT 1010
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-1651
Mailing Address - Country:US
Mailing Address - Phone:602-741-8760
Mailing Address - Fax:214-826-0130
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:SUITE 510
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:214-824-2510
Practice Address - Fax:214-826-0130
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPF1097242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist