Healthcare Provider Details

I. General information

NPI: 1326513557
Provider Name (Legal Business Name): JENNIFER LEIGH MATTHEWS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER SHIPMAN NP

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PINNACLE POINT DR
COLUMBIA SC
29223-5735
US

IV. Provider business mailing address

1040 PINNACLE POINT DR
COLUMBIA SC
29223-5735
US

V. Phone/Fax

Practice location:
  • Phone: 803-319-4401
  • Fax:
Mailing address:
  • Phone: 803-509-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22249
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: