MEDICARE: JESSICA GARRETT

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	229917	SC

General Provider Information

NPI Number	:	1215864798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GARRETT

Provider Business Mailing Address
First Line	:	2450 INDIA HOOK RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3270
Country	:	US
Telephone Number	:	803-366-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 INDIA HOOK RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3270
Country	:	US
Telephone Number	:	803-366-7443
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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