Healthcare Provider Details

I. General information

NPI: 1013822246
Provider Name (Legal Business Name): JENNA MCKAY GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5523 SOFT SHELL DR
LANCASTER SC
29720-0458
US

IV. Provider business mailing address

5523 SOFT SHELL DR
LANCASTER SC
29720-0458
US

V. Phone/Fax

Practice location:
  • Phone: 410-292-9370
  • Fax:
Mailing address:
  • Phone: 410-292-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31140
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: