MEDICARE: MS. JESSIE LILA SEIDE APRN, PMHNP-BC

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	5010547	NC
2	363L00000X	Nurse Practitioner	335403	NY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404626	NY
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20625	SC
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5010547	NC
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC004993	MD

General Provider Information

NPI Number	:	1578638755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSIE LILA SEIDE APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	6156 ST. ANDREWS RD.
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212
Country	:	US
Telephone Number	:	803-201-3078
Fax Number	:

Provider Business Practice Location Address
First Line	:	6156 ST ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212
Country	:	US
Telephone Number	:	803-201-3078
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	12/09/2025

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