Healthcare Provider Details

I. General information

NPI: 1154268811
Provider Name (Legal Business Name): JESSICA URANIA FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 EAGLE LANDING BLVD
HANAHAN SC
29410-8517
US

IV. Provider business mailing address

2492 ETIWAN AVE
CHARLESTON SC
29414-5567
US

V. Phone/Fax

Practice location:
  • Phone: 843-327-4013
  • Fax:
Mailing address:
  • Phone: 843-327-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number31814
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: