Healthcare Provider Details

I. General information

NPI: 1477200517
Provider Name (Legal Business Name): SUMMER M JENKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 MYRTLE TRACE DR STE 200
CONWAY SC
29526-8945
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8041
  • Fax: 843-347-8042
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25880
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: