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General NPI Number Information
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NPI Number | 1841913845
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Entity Type | Individual
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Provider Name | JENNIFER LEAH STAYTON APRN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 4969 CENTRE POINTE DR STE 100
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-6975
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Country | US
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Telephone | 843-725-5444
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Fax | 843-266-9124
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Provider Business Mailing Address
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Address Line | 4969 CENTRE POINTE DR STE 100
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-6975
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Country | US
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Telephone | 843-725-5444
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Fax | 843-266-9124
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26757
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26757
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License Number State | SC
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