Healthcare Provider Details

I. General information

NPI: 1063397529
Provider Name (Legal Business Name): JAMEKA EARLE COSMETOLOGIST
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 ROMANY CT
BOILING SPRINGS SC
29316-9346
US

IV. Provider business mailing address

1326 ROMANY CT
BOILING SPRINGS SC
29316-9346
US

V. Phone/Fax

Practice location:
  • Phone: 864-510-9197
  • Fax:
Mailing address:
  • Phone: 864-510-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number90092
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: