Provider Demographics
NPI:1487899373
Name:WILKES, CHARLOTTE S (CNM)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:S
Last Name:WILKES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:R
Other - Last Name:SALINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2208 PARK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-1466
Practice Address - Country:US
Practice Address - Phone:803-531-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60964147367A00000X
COC-APN.0001056-C-CNM367A00000X
IDCNM-52A367A00000X
NJ25ME00080801367A00000X
SC25546367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135513Medicaid
SCMW0309Medicaid
ID808229500Medicaid