Individual
JENNA KAYE WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 789-1892
(843) 606-8036
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(251) 415-8602
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
81716
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
817166
—
SC
Enumeration date
04/08/2014
Last updated
07/13/2020
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