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NPI Code Detail

MEDICARE: SHELLY C WILKERSON NP

MEDICARE:   SHELLY C WILKERSON  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner61322SC

General Provider Information

NPI Number : 1710996129
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY C WILKERSON NP
Provider Business Mailing Address
First Line : 2001 LAUREL ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-1018
Country : US
Telephone Number : 803-255-2655
Fax Number : 803-376-2870
Provider Business Practice Location Address
First Line : 1330 HAILE ST
Second Line :
City : CAMDEN
State : SC
Zip : 29020-3002
Country : US
Telephone Number : 803-432-6771
Fax Number : 803-376-2870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 01/28/2016

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Directions to “ SHELLY C WILKERSON NP” Practice Location

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