Wildman, Jenna Kaye
Wildman, Jenna Kaye is an individual health care provider with primary practice located at 2095 Henry Tecklenburg Dr , Charleston SC 29414-5733. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Wildman, Jenna Kaye can be contacted via phone (843) 789-1892.Contact Information
Primary practice address
2095 Henry Tecklenburg Dr
Charleston SC 29414-5733
Phone: (843) 789-1892
Fax: (843) 606-8036
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 81716 | South Carolina |
Profile Details
| NPI number | 1174942064 |
|---|---|
| LBN Legal business name | Wildman, Jenna Kaye |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 8th, 2014 |
| Last updated | Jul 13th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174942064 | NPPES |
| South Carolina | MEDICAID | 817166 |
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