Healthcare Provider Details

I. General information

NPI: 1255859682
Provider Name (Legal Business Name): JESSICA LEOPARD CAUBLE FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 MEDICAL RIDGE RD
CLINTON SC
29325-4541
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5654
  • Fax: 864-833-2786
Mailing address:
  • Phone: 864-454-5110
  • Fax: 864-241-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21227
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: