Provider Demographics
NPI:1871371757
Name:WILBANKS, ABIGAIL DAWN (DPH)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DAWN
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 COLES CRK
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2363
Mailing Address - Country:US
Mailing Address - Phone:405-820-0804
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7214
Practice Address - Country:US
Practice Address - Phone:405-684-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist