Audrey Anne Wildeman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2742 Issued in SC

Practice address

3021 Reidville Rd
Spartanburg, SC 29301-5643

Phone

(864) 576-9201

Fax

(864) 576-6584

NPI assigned

Aug 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Physicians of Spartanburg, PC

  • Family Medicine Physician
  • Spartanburg, SC
  • NPI 1629228382
  Medicare reassignment

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1437675469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 REIDVILLE RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015643",
            "telephone_number": "864-576-9201",
            "fax_number": "864-576-6584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 REIDVILLE RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015643",
            "telephone_number": "864-576-9201",
            "fax_number": "864-576-6584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEMAN",
        "first_name": "AUDREY",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Wienand
• Elliott Wilch, PHARMD
• Brooke Ashley Wilcox, PMHNP
• Jennifer Poole Wilcox, O.D.
• Margaret Ellen Wilcox, ADC-P
• Douglas Larry Wiley, D.O.
• Cortella Wilkes, DNP
• Stefan James Wilkes, DMD
• Wilkins Opticians of Spartanburg,Inc
• Ava L Wilkins

• Physician Assistant in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.