MEDICARE: JARVIA BREONNE MEGGETT

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	255737	SC

General Provider Information

NPI Number	:	1619677218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARVIA BREONNE MEGGETT

Provider Business Mailing Address
First Line	:	40 RIVERSIDE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-3249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 RIVERSIDE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-3249
Country	:	US
Telephone Number	:	843-737-3570
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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