Healthcare Provider Details

I. General information

NPI: 1205203502
Provider Name (Legal Business Name): JENNIFER WHITE PATTERSON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 HIGHWAY 76 E
CLINTON SC
29325-7527
US

IV. Provider business mailing address

22725 HIGHWAY 76 E
CLINTON SC
29325-7527
US

V. Phone/Fax

Practice location:
  • Phone: 864-547-8304
  • Fax: 864-938-2881
Mailing address:
  • Phone: 864-547-8304
  • Fax: 864-938-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19626
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: