=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871285098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAYE D JENNINGS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2023
-----------------------------------------------------
Last Update Date | 05/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 W MARTINTOWN RD STE 200
-----------------------------------------------------
City | NORTH AUGUSTA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29841-6104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-265-5201
-----------------------------------------------------
Fax | 803-708-0865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7227
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29171-7227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-244-9212
-----------------------------------------------------
Fax | 803-708-0865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 27393
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------