Healthcare Provider Details

I. General information

NPI: 1508185505
Provider Name (Legal Business Name): JAMIE LEE REIDY MSN, PNP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2010
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 EDEN TER
ROCK HILL SC
29730-3622
US

IV. Provider business mailing address

572 JOHN ROSS PKWY STE 107
ROCK HILL SC
29730-8975
US

V. Phone/Fax

Practice location:
  • Phone: 301-643-8127
  • Fax:
Mailing address:
  • Phone: 301-643-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number31409A
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number31409A
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: