Healthcare Provider Details

I. General information

NPI: 1306409347
Provider Name (Legal Business Name): MRS. VICKIE D WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 MILLS AVE
GREENVILLE SC
29605-4021
US

IV. Provider business mailing address

331 MILLS AVE
GREENVILLE SC
29605-4021
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-3999
  • Fax:
Mailing address:
  • Phone: 864-232-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number403
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: