Provider Demographics
NPI:1225682404
Name:WILKES, SHARDA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:SHARDA
Middle Name:RENEE
Last Name:WILKES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 TILGHMAN RD N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1919
Mailing Address - Country:US
Mailing Address - Phone:252-640-0827
Mailing Address - Fax:
Practice Address - Street 1:401 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2885
Practice Address - Country:US
Practice Address - Phone:252-830-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse