Healthcare Provider Details

I. General information

NPI: 1629002811
Provider Name (Legal Business Name): JYMEE ANN CHICKO RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8903
US

IV. Provider business mailing address

4741 BUCKLEY CT
MYRTLE BEACH SC
29579-6902
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5060
  • Fax:
Mailing address:
  • Phone: 834-903-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR87364
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: