Healthcare Provider Details

I. General information

NPI: 1376555979
Provider Name (Legal Business Name): CICELY W JENKINS R.N.,B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THOMSON STUDENT HEALTH CTR UNIVERSITY OF SOUTH CAROLINA
COLUMBIA SC
29208-0001
US

IV. Provider business mailing address

6045 CEDARIDGE RD
COLUMBIA SC
29206-4301
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-3669
  • Fax: 803-777-0126
Mailing address:
  • Phone: 803-787-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number20552
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: