Healthcare Provider Details

I. General information

NPI: 1538333695
Provider Name (Legal Business Name): JACQUELYN RENEE HEDMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CLYBURN PL
AIKEN SC
29801-4193
US

IV. Provider business mailing address

500 DUNCAN RD.
NORTH AUGUSTA SC
29841-8101
US

V. Phone/Fax

Practice location:
  • Phone: 803-380-7010
  • Fax:
Mailing address:
  • Phone: 706-533-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN182772
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number182772
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11000933
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22343A
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: