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General NPI Number Information
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NPI Number | 1982100285
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Entity Type | Individual
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Provider Name | JESSIE PERNELL GOETHIE DNP, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1680 RIBAUT RD
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City | PORT ROYAL
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State | SC
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Zip | 29935-2008
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Country | US
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Telephone | 843-522-7190
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Fax | 843-379-9686
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Provider Business Mailing Address
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Address Line | 1680 RIBAUT RD
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City | PORT ROYAL
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State | SC
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Zip | 29935-2008
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Country | US
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Telephone | 843-522-7193
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Fax | 843-379-9686
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21756
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License Number State | SC
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