Healthcare Provider Details

I. General information

NPI: 1316456478
Provider Name (Legal Business Name): JENNIFER REPASKEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SPRINGVIEW LN
SUMMERVILLE SC
29485-8153
US

IV. Provider business mailing address

92 SPRINGVIEW LN
SUMMERVILLE SC
29485-8153
US

V. Phone/Fax

Practice location:
  • Phone: 843-871-4006
  • Fax: 843-871-4074
Mailing address:
  • Phone: 843-871-4006
  • Fax: 843-871-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberLL2830
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2830
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: