MEDICARE: JENNIFER L MCCARTHY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	28731	SC

General Provider Information

NPI Number	:	1205675915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L MCCARTHY FNP-C

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTENTION PNS CREDENTIALING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:	843-234-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 62ND AVE N
Second Line	:	STE A
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-7202
Country	:	US
Telephone Number	:	843-839-0957
Fax Number	:	843-839-0758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	08/30/2024

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