Individual
REBECCA LYNN WILKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
333 REVOLUTIONARY TRAIL, FAIRFAX, SC 29827
(803) 632-2533
(803) 632-2451
Mailing address
86 WREN ST, BARNWELL, SC 29812
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
APRN19904
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19904
MEDICAL LICENSE
SC
05
—
NP3909
—
SC
01
—
P01901354
RR MEDICARE
SC
Enumeration date
03/20/2006
Last updated
06/30/2021
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