Provider Demographics
NPI:1679094601
Name:SMITH CHASSE, JESSICA GRACE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:GRACE
Last Name:SMITH CHASSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 RENEE DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4358
Mailing Address - Country:US
Mailing Address - Phone:843-903-4500
Mailing Address - Fax:843-903-4505
Practice Address - Street 1:3874 RENEE DR UNIT D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4358
Practice Address - Country:US
Practice Address - Phone:843-903-4500
Practice Address - Fax:843-903-4505
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5421070363LF0000X, 207Q00000X
SC21070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1780697151OtherMEDICARE/PRIVATE PAY