Healthcare Provider Details

I. General information

NPI: 1346618618
Provider Name (Legal Business Name): JENNIFER CAMPBELL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7801
US

IV. Provider business mailing address

2295 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7801
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-7103
  • Fax: 843-763-3834
Mailing address:
  • Phone: 843-766-7103
  • Fax: 843-763-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR0105340
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: