Provider Demographics
NPI:1871285098
Name:JENNINGS, FAYE D (NP)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7227
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-7227
Mailing Address - Country:US
Mailing Address - Phone:803-244-9212
Mailing Address - Fax:803-708-0865
Practice Address - Street 1:440 W MARTINTOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6104
Practice Address - Country:US
Practice Address - Phone:803-265-5201
Practice Address - Fax:803-708-0865
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC27393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily