MEDICARE: FAYE D JENNINGS NP

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	27393	SC

General Provider Information

NPI Number	:	1871285098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE D JENNINGS NP

Provider Business Mailing Address
First Line	:	PO BOX 7227
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-7227
Country	:	US
Telephone Number	:	803-244-9212
Fax Number	:	803-708-0865

Provider Business Practice Location Address
First Line	:	440 W MARTINTOWN RD STE 200
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-6104
Country	:	US
Telephone Number	:	803-265-5201
Fax Number	:	803-708-0865

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/22/2024

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