Provider Demographics
NPI:1144575499
Name:WICHERS, BRITTANY S (PA-C)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:S
Last Name:WICHERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 S SUBER RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-0944
Mailing Address - Country:US
Mailing Address - Phone:864-686-7981
Mailing Address - Fax:
Practice Address - Street 1:3025 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2715
Practice Address - Country:US
Practice Address - Phone:864-686-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6498363A00000X
SCPA3207363A00000X
FLPA9109200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168581Medicaid
GA003126324Medicaid
GA202I978773Medicare PIN