MEDICARE: JEREMY L ADAMS 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	363L00000X	Nurse Practitioner	5010876	NC

General Provider Information

NPI Number	:	1568942696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY L ADAMS FNP-C

Provider Business Mailing Address
First Line	:	1808 SECOND BAXTER XING
Second Line	:	STE 108
City	:	FORT MILL
State	:	SC
Zip	:	29708-6437
Country	:	US
Telephone Number	:	803-802-2225
Fax Number	:	803-802-2275

Provider Business Practice Location Address
First Line	:	1808 SECOND BAXTER XING
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6436
Country	:	US
Telephone Number	:	803-802-2225
Fax Number	:	803-802-2275

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

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	05/12/2020

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