Provider Demographics
NPI:1326166059
Name:MOTLEY, JANET REYNOLDS (NP)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:REYNOLDS
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 VILLAGE WALK LN
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-3304
Mailing Address - Country:US
Mailing Address - Phone:864-650-1187
Mailing Address - Fax:
Practice Address - Street 1:940 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-536-2725
Practice Address - Fax:803-534-3118
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC145363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics