Provider Demographics
NPI:1376987255
Name:WATTERS, JENNIFER SMITH (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SMITH
Last Name:WATTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-1939
Mailing Address - Country:US
Mailing Address - Phone:864-429-1735
Mailing Address - Fax:864-429-2828
Practice Address - Street 1:120 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-1939
Practice Address - Country:US
Practice Address - Phone:864-429-1735
Practice Address - Fax:864-429-2828
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC205667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse