Individual
JACQUELINE GABRIELLE WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
200 BOOKER DR, WALHALLA, SC 29691-2278
(864) 656-3076
(843) 985-9562
Mailing address
200 BOOKER DR, WALHALLA, SC 29691-2278
(864) 656-3076
(843) 985-9562
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23172
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6253
—
SC
Enumeration date
08/20/2019
Last updated
06/18/2025
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