Healthcare Provider Details

I. General information

NPI: 1790102044
Provider Name (Legal Business Name): JESSICA MICHELLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 POINTE CIR STE 3102
GREENVILLE SC
29615-6307
US

IV. Provider business mailing address

68 POINTE CIR STE 3102
GREENVILLE SC
29615-6307
US

V. Phone/Fax

Practice location:
  • Phone: 803-403-0294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number211333
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25364
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number25364
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: