Healthcare Provider Details

I. General information

NPI: 1083561104
Provider Name (Legal Business Name): MEAGAN WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 CAMELLIA BLOOM DR
MONCKS CORNER SC
29461-6506
US

IV. Provider business mailing address

278 CAMELLIA BLOOM DR
MONCKS CORNER SC
29461-6506
US

V. Phone/Fax

Practice location:
  • Phone: 843-452-4186
  • Fax:
Mailing address:
  • Phone: 843-452-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number240703
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: