Healthcare Provider Details

I. General information

NPI: 1508729328
Provider Name (Legal Business Name): ALEXANDRA NICOLE JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WINGO WAY STE 106
MT PLEASANT SC
29464-1810
US

IV. Provider business mailing address

305 SALAMANDER CT
HUGER SC
29450-8504
US

V. Phone/Fax

Practice location:
  • Phone: 843-410-0597
  • Fax:
Mailing address:
  • Phone: 203-500-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number31315
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: