Healthcare Provider Details

I. General information

NPI: 1740114545
Provider Name (Legal Business Name): JENNETTE MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNETTE CHARLES-MARTIN RN

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 STURGIS RD
ROCK HILL SC
29730-6673
US

IV. Provider business mailing address

1238 LITTLE ROY LN
CATAWBA SC
29704-7779
US

V. Phone/Fax

Practice location:
  • Phone: 839-388-5581
  • Fax:
Mailing address:
  • Phone: 843-957-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number218292
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: