Provider Demographics
NPI:1659798429
Name:WILKIE, REGAN
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 OLD LAURENS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9782
Mailing Address - Country:US
Mailing Address - Phone:864-993-8843
Mailing Address - Fax:
Practice Address - Street 1:613 NEWBERRY HWY
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-8903
Practice Address - Country:US
Practice Address - Phone:864-445-2141
Practice Address - Fax:864-445-7668
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse