Kendall L Wilson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

89836 Issued in SC

Practice address

155 Academy Ave
Greenwood, SC 29646-3869

Phone

(864) 725-4865

NPI assigned

Jun 14, 2023

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwilson539991@selfregional.direct-ci.net

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.

• Self Medical Group

  • Surgery Physician
  • Greenwood, SC
  • NPI 1982836847
  Medicare reassignment NPD
• Self Regional Healthcare Partners

  dba Edgefield County Healthcare, An Affiliate of Self Regional Healthcare

  • Critical Access Hospital
  • Edgefield, SC
  • NPI 1922582105

  Family Medicine

  Medicare reassignment NPD
• Self Regional Healthcare

  dba Montgomery Center for Family Medicine of SRH

  • Family Medicine Physician
  • Greenwood, SC
  • NPI 1326067703
  Medicare reassignment
• Self Medical Group

  • Diagnostic Radiology Physician
  • Greenwood, SC
  • NPI 1659839694
  NPD
• Self Medical Group

  • Emergency Medicine Physician
  • Greenwood, SC
  • NPI 1740788165
  NPD
• Self Regional Healthcare

  dba Self Medical Center Laurens

  • Family Medicine Physician
  • Laurens, SC
  • NPI 1114726460
  NPD
• Self Regional Healthcare

  dba Self Regional Neurology

  • Neurology Physician
  • Greenwood, SC
  • NPI 1285502559
  NPD
• Self Regional Healthcare Partners

  dba Edgefield Community Pharmacy

  • Community/Retail Pharmacy
  • Edgefield, SC
  • NPI 1073486494
  NPD
• Self Medical Group

  dba Advanced Gastroenterology

  • Gastroenterology Physician
  • Greenwood, SC
  • NPI 1841047560
  NPD (past)
• Self Regional Healthcare

  dba Self Medical Center Newberry

  • Family Medicine Physician
  • Newberry, SC
  • NPI 1548068398
  NPD (past)

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1578247086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463837",
            "telephone_number": "864-725-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-4865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22580 Highway 76 E Ste 300",
            "address_purpose": "LOCATION",
            "city": "Laurens",
            "state": "SC",
            "postal_code": "293608460",
            "country_code": "US",
            "telephone_number": "864-939-1070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "102 Rockcreek Blvd",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296498915",
            "country_code": "US",
            "telephone_number": "864-725-5020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 Spring St",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463860",
            "country_code": "US",
            "telephone_number": "864-725-4780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KENDALL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "89836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyisha Lashay Williams
• Brittany Williamson
• Carol Wilson
• Cynthia Wilson
• Gregory Lee Wilson, M. ED.
• Maria Lorena Wilson, COTA
• Taja Wilson
• Valerie Chapman Wilson, FNP-BC
• Victoria Moton Wilson
• Zachary Wilson

• Family Medicine Physician in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.