Provider Demographics
NPI:1285966036
Name:WILKES, LAVENA S (NP)
Entity type:Individual
Prefix:
First Name:LAVENA
Middle Name:S
Last Name:WILKES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3834
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29608
Mailing Address - Country:US
Mailing Address - Phone:864-230-1665
Mailing Address - Fax:844-596-0411
Practice Address - Street 1:222 ADLEY WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-230-1665
Practice Address - Fax:844-596-0411
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4075363LP0808X
SCAPRN4075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health