Healthcare Provider Details

I. General information

NPI: 1538606603
Provider Name (Legal Business Name): JESSICA TRAYWICK HOPKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA TRAYWICK NP

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DOCTORS DR
GREENVILLE SC
29605-5608
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7060
  • Fax: 864-797-7065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20362
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: