Provider Demographics
NPI:1326602137
Name:WILKIE, KATHRYN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:WILKIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-295-2308
Mailing Address - Fax:864-295-0396
Practice Address - Street 1:15 ROE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7423
Practice Address - Country:US
Practice Address - Phone:864-295-2308
Practice Address - Fax:864-295-0396
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL3201363A00000X
SC3201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3234PAMedicaid