Individual
JENNIFER LOGAN WILKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Mailing address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3505
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4124PA
—
SC
05
—
PA4124
—
SC
Enumeration date
08/09/2019
Last updated
11/09/2022
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