MEDICARE: JENNINGS MICHAEL PERRY DNP

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	163W00000X	Registered Nurse	353367	OH
2	363LF0000X	Family Nurse Practitioner	17756	OH
3	363LP2300X	Primary Care Nurse Practitioner	20499	SC

General Provider Information

NPI Number	:	1851684674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNINGS MICHAEL PERRY DNP

Provider Business Mailing Address
First Line	:	728 CONIFER CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4172
Country	:	US
Telephone Number	:	614-203-3515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 48TH AVE N # A-2
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5427
Country	:	US
Telephone Number	:	843-855-2299
Fax Number	:

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

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	02/19/2025

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