Marqeita Wilds, COSMETOLOGLY LICENSE

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

RC56060 Issued in SC

Practice address

108 Columbia Northeast Dr
Columbia, SC 29223-6433

Phone

(803) 629-1186

NPI assigned

Oct 31, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1427765429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23581",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292243581",
            "telephone_number": "803-629-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 COLUMBIA NORTHEAST DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236433",
            "telephone_number": "803-629-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDS",
        "first_name": "MARQEITA",
        "name_prefix": "Ms.",
        "credential": "COSMETOLOGLY LICENSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "SC",
            "license": "RC56060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Blackberry",
            "affiliation": "N",
            "endpointDescription": "Client medical records",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Client  medical records",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client medical records",
            "address_1": "108 Columbia Northeast Dr",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292236433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Chrsitian Wilder I
• Lauren Nicole Wildes
• Wildewood Downs Retirement LLC
• Wildewood Retirement LLC
• Anna Kathryn Wilds
• Charles Henry Wile, MD
• Rachel Wiler, PA-C
• Jacquelyn L Wiles, DDS
• Brian R. Wiley, P.T.
• Sarah N Wilhelm, PHARM.D.

• Prosthetics Case Management in Columbia, SC
• Providers in Columbia, SC by specialty
• Prosthetics Case Management in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.