Healthcare Provider Details

I. General information

NPI: 1851259659
Provider Name (Legal Business Name): JENNIFER KRISTY REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TRADERS CROSS
BLUFFTON SC
29909-4637
US

IV. Provider business mailing address

110 TRADERS CROSS
BLUFFTON SC
29909-4637
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-7412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number32330
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: