Healthcare Provider Details

I. General information

NPI: 1497272421
Provider Name (Legal Business Name): JAYME LEIGH MASON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S ALLIANCE DR STE 211B
GOOSE CREEK SC
29445-7269
US

IV. Provider business mailing address

201 SIGMA DR STE 100
SUMMERVILLE SC
29486-7722
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-4383
  • Fax: 843-553-4384
Mailing address:
  • Phone: 843-553-4383
  • Fax: 843-553-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21246
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: