Healthcare Provider Details

I. General information

NPI: 1548845944
Provider Name (Legal Business Name): JESSICA POWELL BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MONTAGUE AVENUE EXT
GREENWOOD SC
29649-9027
US

IV. Provider business mailing address

1225 MONTAGUE AVENUE EXT
GREENWOOD SC
29649-9027
US

V. Phone/Fax

Practice location:
  • Phone: 864-519-0054
  • Fax: 864-447-5707
Mailing address:
  • Phone: 864-519-0054
  • Fax: 864-447-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number24785
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: