MEDICARE: JAMMIE EMERSON NP-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	363LF0000X	Family Nurse Practitioner	20864	SC

General Provider Information

NPI Number	:	1952833279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMMIE EMERSON NP-C

Provider Business Mailing Address
First Line	:	8203 NIGELS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4177
Country	:	US
Telephone Number	:	843-491-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	8203 NIGELS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4177
Country	:	US
Telephone Number	:	843-491-1630
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/20/2020

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