MEDICARE: MRS. MAURIAN JENKINS AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	19876	SC
2	363LG0600X	Gerontology Nurse Practitioner	19876	SC

General Provider Information

NPI Number	:	1376900126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAURIAN JENKINS AGNP

Provider Business Mailing Address
First Line	:	202 WALL ST
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-6754
Country	:	US
Telephone Number	:	864-295-8714
Fax Number	:	864-295-8764

Provider Business Practice Location Address
First Line	:	202 WALL ST
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-6754
Country	:	US
Telephone Number	:	864-295-8714
Fax Number	:	864-295-8764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	04/19/2016

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