Healthcare Provider Details

I. General information

NPI: 1245919224
Provider Name (Legal Business Name): JENNIFER LYNN PARDUE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PRISON RD
ENOREE SC
29335-2719
US

IV. Provider business mailing address

109 HARRISON RD
EASLEY SC
29642-9348
US

V. Phone/Fax

Practice location:
  • Phone: 803-729-7974
  • Fax:
Mailing address:
  • Phone: 843-834-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number27559
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: