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General NPI Number Information
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NPI Number | 1851684674
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Entity Type | Individual
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Provider Name | JENNINGS MICHAEL PERRY DNP
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Gender | Male
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1301 48TH AVE N # A-2
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5427
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Country | US
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Telephone | 843-855-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 728 CONIFER CT
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4172
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Country | US
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Telephone | 614-203-3515
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 353367
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17756
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 20499
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License Number State | SC
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