| Name: | RUTHANNE WILKES LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Mar 2018 (7 years ago) |
| Entity Number: | 000-511-232 |
| Register Number: | 000511232 |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 6501 US HWY 431 NHEADLAND, AL 36345-5657 |
| Registered Office Mailing Address: | 1101 BURBANK STDOTHAN, AL 36303-2417 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043717580 | 2018-04-11 | 2018-04-11 | 256 HONEYSUCKLE RD STE 2, DOTHAN, AL, 363051168, US | 256 HONEYSUCKLE ROAD, SUITE 2, DOTHAN, AL, 363051168, US | |||||||||||||||||||||||||
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| Phone | +1 334-792-6736 |
| Fax | 3347926737 |
Authorized person
| Name | MRS. RUTHANNE WILKES |
| Role | OWNER |
| Phone | 3347926736 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| License Number | 1-074982 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 179654 |
| State | AL |
| Name | Role |
|---|---|
| WILKES, RUTHANNE | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
