Healthcare Provider Details

I. General information

NPI: 1558080234
Provider Name (Legal Business Name): KAYLA WILKES RN, CLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 STEWART GIN RD
LIBERTY SC
29657-9001
US

IV. Provider business mailing address

210 STEWART GIN RD
LIBERTY SC
29657-9001
US

V. Phone/Fax

Practice location:
  • Phone: 803-609-9761
  • Fax:
Mailing address:
  • Phone: 803-609-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLA WILKES
Title or Position: LACTATION COUNSELOR
Credential: RN, BSN, IBCLC
Phone: 803-609-9761