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General NPI Number Information
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NPI Number | 1164118907
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Entity Type | Individual
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Provider Name | JENNIFER M GREGORY NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK DR
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City | CHESTER
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State | SC
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Zip | 29706-9769
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Country | US
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Telephone | 803-581-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 MINSTRELS WAY
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City | INDIAN LAND
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State | SC
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Zip | 29707-7785
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Country | US
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Telephone | 803-320-0233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 27273
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License Number State | SC
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