Healthcare Provider Details

I. General information

NPI: 1558707885
Provider Name (Legal Business Name): JODY MELISSA PARNELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PROFESSOR BROWN LN
STARR SC
29684-9506
US

IV. Provider business mailing address

PO BOX 118
IVA SC
29655-0118
US

V. Phone/Fax

Practice location:
  • Phone: 864-352-6154
  • Fax: 864-352-6158
Mailing address:
  • Phone: 864-348-6196
  • Fax: 864-348-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61046
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: