Healthcare Provider Details

I. General information

NPI: 1720824600
Provider Name (Legal Business Name): JESSICA ANN PRAY-HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BISHOP GADSDEN WAY STE 97
CHARLESTON SC
29412-3506
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-406-2362
  • Fax: 843-606-8082
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28959
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: