Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 25211 | SC |
NPI | 1003583246 |
---|---|
Provider Name | Jennifer Lucas Reid |
First Address | Timmonsville, SC 29161-7861 |
Second Address | Manning, SC 29102-3153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2021 |
Last Update Date | 25/08/2021 |