Healthcare Provider Details

I. General information

NPI: 1548126162
Provider Name (Legal Business Name): JENNIFER SMITH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MARINA DR
GEORGETOWN SC
29440-2410
US

IV. Provider business mailing address

237 CHESAPEAKE LN
MURRELLS INLET SC
29576-5782
US

V. Phone/Fax

Practice location:
  • Phone: 843-833-8595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number29824
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29824
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: