Healthcare Provider Details

I. General information

NPI: 1730670357
Provider Name (Legal Business Name): CHYRESE JENKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 MAGNOLIA ST
ORANGEBURG SC
29118-1403
US

IV. Provider business mailing address

3709 MAGNOLIA ST
ORANGEBURG SC
29118-1403
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-2220
  • Fax: 803-531-7975
Mailing address:
  • Phone: 803-531-2220
  • Fax: 803-531-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21503
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: