Healthcare Provider Details

I. General information

NPI: 1154265676
Provider Name (Legal Business Name): MR. JACQUE KERRY VARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ORCHARD DR
INMAN SC
29349-9647
US

IV. Provider business mailing address

170 ORCHARD DR
INMAN SC
29349-9647
US

V. Phone/Fax

Practice location:
  • Phone: 864-990-0329
  • Fax: 864-708-3197
Mailing address:
  • Phone: 864-990-0329
  • Fax: 864-708-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: